bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin improves clinical status of patients with cystic‐fibrosis‐related diabetes mellitus
Authors: Nousia‐Arvanitakis S , Galli‐Tsinopoulou A , Karamouzis M
Published: August 2010

Cystic‐fibrosis‐related diabetes mellitus is frequently underdiagnosed and associated with deterioration of overall clinical status. The purpose of this prospective study was to investigate the influence of insulin on nutrition, lung function and clinical status of cystic fibrosis patients. For a period of 5y, and at 6‐mo intervals, body mass index, forced expiratory volume in 1 sec, Shwachman score, intravenous glucose tolerance test and first‐phase insulin response were determined in 30 cystic fibrosis patients (age range 10–35 y) with exocrine pancreatic insufficiency. During the study period, six patients (3M and 3F; age range 15–22 y) developed diabetes and required insulin therapy. The decrease of first‐phase insulin response coincided with deterioration of nutritional and clinical status, which improved significantly 6 mo after the institution of insulin.

Conclusion: Insulin, as an anabolic hormone, could have an influence on body mass, which may affect pulmonary function and clinical condition in cystic fibrosis. It is important to identify cystic fibrosis individuals at risk of developing diabetes so that early insulin therapy is instituted.
Traumatic experiences and post‐traumatic stress reactions in children from Kurdistan and Sweden
Authors: Sundelin‐Wahlsten V , Ahmad A , von Knorring A‐L
Published: August 2010

This paper examines the types and scores of traumatic experiences, post‐traumatic stress symptom and behavioural disorders among Kurdistanian refugee children in Sweden and a comparative Swedish group. The Harvard‐Uppsala Trauma Questionnaire for Children (HUTQ‐C), the Post‐Traumatic Stress Disorder for Children (PTSS‐C) and the Child Behaviour Checklist (CBCL) were administered in interview form to 32 children from each sample, controlled for age, gender and trauma levels. No significant differences were found between the 2 samples regarding types of traumatic events, frequencies of post‐traumatic stress disorder, post‐traumatic stress symptom scores or behavioural problem scores, except in 3 aspects: Kurdistanian children reported more war experience and being lost, while Swedish children presented higher frequencies of leisure‐time accidents.

Conclusion: This study supports the assumption that children differ from adults by showing more similarities than differences regarding traumatic experiences and post‐traumatic stress reactions, after being exposed to an equivalent number of reported traumatic events. The refugee children's stay in Sweden can be considered as a healing factor.
Nitric oxide production during the early neonatal period in small‐for‐gestational‐age infants
Authors: Wijnberger LDE , Krediet TG , Egberts J , van Bel F
Published: August 2010

In a study of endogenous nitric oxide production in growth‐retarded, very preterm newborns <32wk GA), urinary NOx/creatinine ratio and plasma guanosine 3′,5′‐cyclic monophosphate levels were determined during the early neonatal period. Newborns were divided into three groups: appropriate‐for‐gestational‐age (AGA, n= 19), moderately small‐for‐gestational‐age (SGA, n= 13) and severely SGA (n= 6) infants. Severely SGA infants showed significant higher values of nitric oxide derivatives during the first 24 h of life compared with the other groups.

Conclusion: An increased NO production is found in SGA infants during the first 24 h after birth. This may reflect an increased intrauterine nitric oxide production in the feto‐placental circulation found in cases with intrauterine growth retardation.
Neurodevelopmental outcome in high‐risk preterm infants treated with inhaled nitric oxide
Authors: Bennett AJ , Shaw NJ , Gregg JE , Subhedar NV
Published: August 2010

Inhaled nitric oxide (iNO) is used to treat preterm infants with hypoxaemic respiratory failure. In this study we describe the long‐term survival and neurodevelopmental status of high‐risk preterm infants enrolled into a randomized controlled trial of iNO therapy. Information regarding long‐term outcome was available for all 25 children enrolled in the original trial who survived until discharge from hospital. Formal, blinded, developmental assessment and neurological examinations were performed in 21 out of 22 children still alive at 30 mo of age, corrected for prematurity. No significant differences were found in long‐term mortality (12/20 vs 8/22, RR 1.65,95% CI 0.87–3.3), neurodevelopmental delay (4/7 vs 9/14, RR 0.89,95% CI 0.37–1.75), severe neurodisability (0/7 vs 5/14, p= 0.12) or cerebral palsy (0/7 vs 2/14, p= 0.53) between iNO‐treated and control infants.

Conclusion: In this study there was no evidence of a significant effect on either survival or long‐term neurodevelopmental status in infants treated with iNO.
Continuing Progressive Deterioration of the Environment in the Aral Sea Region: Disastrous Effects on Mother and Child Health
Authors: Ataniyazova O , Adrian S , Mazhitova Z , Moshammer H , Prindull G , Zetterström R
Published: August 2010

Scientists, non‐governmental experts (NGOs) and governmental officials from the Central Asian Republics and an international group of invited scientists and NGO representatives participated in a workshop on the disastrous health problems in the Aral Sea Region. Various serious problems were reported in more than 20 presentations. Particular emphasis was put on the way in which adverse environmental factors such as contaminated water and food have contributed to the deterioration of human health, particularly that of mothers and children.

Conclusion: There is an urgent request that the international community assists local scientists to develop programmes to improve the health of the population in the Aral Sea Region.
Influence of incubator humidity on sleep and behaviour of neonates kept at stable body temperature
Authors: Telliez F , Bach V , Delanaud S , Leke A , Abdiche M , Chardon K
Published: August 2010

The influence of incubator air humidity (via passive humidification through use of a water reservoir or via active humidification to 2 and 4 kPa) on sleep and behavioural changes was investigated in 13 neonates. The thermal environment of the incubator was servocontrolled via an interactive device tracking the skin temperature changes of the neonates. Using this servocontrolled skin temperature derivative heating programme, it is believed that an increase in air moisture content (reducing evaporative skin cooling) can be counterbalanced by a fall in neutral air temperature, so as to keep the body thermally constant. This procedure permits the experimental evaluation of the specific effect of air humidity on the thermal equilibrium air temperature and the thermal comfort of neonates without eliciting thermoregulatory mechanisms. Under the experimental conditions, in order to keep body temperature stable an increase in water vapour partial pressure from 1.72 (water reservoir) to 3.99 kPa (produced by a nebulizer) is counterbalanced by a decrease in air temperature of 1.49°C. Within this humidity range, the air temperature must be lowered by 0.05°C when the vapour pressure is increased by 0.08 kPa. The magnitude of this deviation depends on the humidity range and is probably a result of changes in the wetted skin area.

Conclusion: When body temperature is kept constant, changes in air humidity do not modify sleep, body motility and respiratory and heart rates in neonates.
Short‐term effects of incubator covers on quiet sleep in stable premature infants
Authors: Hellström‐Westas L , Inghammar M , Isaksson K , Rosén I , Stjernqvist K
Published: August 2010

Incubator covers are increasingly being used in neonatal care as part of minimal disturbance strategies. The aim of this study was to examine possible effects of incubator covers on sleep patterns in stable premature infants. Quiet sleep (QS) can be investigated by amplitude‐integrated electroencephalography (aEEG) at 32‐34 wk gestational age. In nine premature infants (gestational ages 26‐32 wk, median 29) QS periods were measured at a postconceptional age of 32‐34 wk (median 34) during two consecutive 24 h periods, one period with a padded dark cover over the incubator and one period without the cover, in a randomized order. There were no significant differences between the two 24 h periods (with incubator cover and without cover, respectively) regarding the duration of the QS periods, the percentage of QS of the total recording time (%QS) or the duration of QS intervals. However, there was a positive correlation between postnatal age in days and the mean duration of QS periods when incubator covers were used (r= 0.90, p= 0.001). When the covers were used there was a difference between the girls and the boys in the duration of QS intervals (p= 0.032); the QS intervals increased in the five girls from median (range) 63.2 (49.4–94.6) min to 77.2 (59.3–100.9) min (p= 0.043). There was no difference in the duration of QS periods between girls and boys.

Conclusion: Incubator covers seem to have some short‐term effects on sleep quality in premature infants but the clinical significance and possible long‐term effects are not known.
Randomized comparative trial between percutaneous longlines and peripheral cannulae in the delivery of neonatal parenteral nutrition
Authors: Ainsworth SB , Furness J , Fenton AC
Published: August 2010

Percutaneously inserted central venous catheters (CVCs) are frequently used for parenteral nutrition (PN) in neonates. Catheter‐related sepsis (CRS) is the most commonly reported complication. The aim of this study was to compare sepsis rates between neonates receiving PN by CVC and by peripheral cannula. Neonates were randomized to receive PN either by CVC or by peripheral cannula. Primary outcomes were sepsis rates and efficacy of PN delivery. Interim analysis (49 neonates) revealed no difference in sepsis rates (CVC group 46%, cannula group 40%, p= 0.57). There was a significant discrepancy in PN delivered (median deficit 3.2% in the CVC group, 10.3% in the cannula group, p= 0.0014). After consideration of these findings the study was terminated.

Conclusion: Because the trial was stopped early, small but clinically important differences in the rates of sepsis may have been missed. Neonates in the cannula group accrued significant deficits of PN owing to a lack of venous access. This may contribute to undernutrition in neonates. CVC can be advocated for PN administration, in that sepsis appears to be no higher than when using cannulae and delivery of nutrition is significantly better.
Interleukin‐8: a valuable tool to restrict antibiotic therapy in newborn infants
Authors: Franz AR , Steinbach G , Kron M , Pohlandt F
Published: August 2010

This study was conducted to evaluate the accuracy and kinetics of interleukin 8 (IL‐8) as a test for early‐onset bacterial infections (EOBI) in neonates and to examine whether IL‐8 would allow “unnecessary” antibiotic therapy to be reduced. First, IL‐8 was measured 378 times on admission, along with C‐reactive protein (CRP), immature to total neutrophil ratio (IT ratio) and blood cultures, in full‐term and preterm neonates with suspected EOBI. Combined culture‐proven and clinical EOBI were detected on admission by the combination of IL‐8 ≥ 70 pg ml−1 and/or CRP > 10 mg 1−1 with 92% sensitivity and 74% specificity. An increased IL‐8 was found in 62% of the infected infants, while CRP was still normal. In a second study period, IL‐8 was determined prospectively in 331 infants who presented clinical signs of EOBI or had a birth history of amniotic infection. Antibiotic therapy was restricted to those infants with suspected infection who also had an increased IL‐8 and/or CRP (n= 158). Another 39 infants received antibiotics on the basis of clinical signs despite negative IL‐8 and CRP. Of 150 non‐infected infants in whom IT ratio, IL‐8 and CRP were available, treatment would have been indicated for 93 infants based on IT ratio and/or CRP (n= 77) or clinical signs (n= 16), but was only initiated in 55 infants based on IL‐8 and/or CRP (n= 28) or clinical signs (n= 27), an apparent reduction in “unnecessary” antibiotic therapy of 40%.

Conclusion: The combination of IL‐8 and CRP is a reliable test for the diagnosis of EOBI and may be helpful in enabling antibiotic therapy to be reduced in newborn infants.
Salbutamol for hyperkalaemia in children
Authors: Helfrich E , de Vries TW , van Roon EN
Published: August 2010

Hyperkalaemia is a potentially fatal disorder that demands direct treatment. The efficacy of traditional medical treatment is unpredictable, limited, of short duration or carries the risk of serious adverse events. The administration of salbutamol for hyperkalaemia in children is described in several clinical trials and case reports.

Conclusion: Salbutamol, inhaled or infused, is safe and efficacious and results in a predictable and long‐lasting reduction in serum potassium. Salbutamol merits a place as the preferred medication for hyperkalaemia in children without arrhythmias. If follow‐up with haemodialysis is required, the administration of salbutamol gives time to make the necessary preparations.
Signal‐averaged electrocardiogram in children and adolescents with insulin‐dependent diabetes mellitus
Authors: Shiono J , Horigome H , Kamoda T , Matsui A
Published: August 2010

We report on the potential usefulness of the signal‐averaged electrocardiogram (SA‐ECG) in young patients with insulin‐dependent diabetes mellitus (IDDM) to predict subclinical cardiovascular complications. Sixteen patients with IDDM and 18 age‐matched healthy subjects were studied. The IDDM group included 4 males and 12 females, aged 7 to 20 y (mean 14.2 ± 3.8 y, ±SD). The duration from the onset of IDDM to the study ranged from 1.2 to 9.8 y (mean 5.4 ± 3.8 y), and HbA1c value ranged from 6.6 to 12.4% (mean, 10.0 ± 1.8%). SA‐ECG was recorded and analyzed using the methods described by Simson. Values of filtered QRS duration (f‐QRS), root mean square voltage (RMS), the duration of low amplitude signal (LAS) and late duration (LD) were calculated and compared between the groups. These parameters were not significantly different between the IDDM and control groups. However, in patients with poor glycemic control (HbA1c > 10%), f‐QRS was long and RMS was significantly low (p < 0.05, each) compared with the control group. Three patients with IDDM were positive for ventricular late potentials, although none had ventricular tachyarrhythmia. None of the control subjects showed ventricular late potentials. Conclusion: Certain parameters of SA‐ECG showed abnormal values in IDDM patients with poor glycemic control. Thus, SA‐ECG is a potentially useful and non‐invasive method for the assessment of subclinical cardiac impairment in diabetic children and adolescents.
Low proportion of familial dilated cardiomyopathy in an Arab population with a high prevalence of consanguineous marriages
Authors: Venugopalan P , Agarwal AK , de Bono D
Published: August 2010

In this study, 770/890 (87%) first‐degree relatives from 108 families of hospitalized patients with idiopathic dilated cardiomyopathy (IDC) were screened using clinical examination, electrocardiography and echocardiography. Thirty percent of the patients were born to consanguineous parents. Familial dilated cardiomyopathy (FDC) was found in 7 (6.5%) families, which is lower than the earlier published figures of 20‐25%. Patients with IDC were younger at presentation (p= 0.002) and were more often associated with parental consanguinity (p= 0.04), but the survival rates of familial patients did not differ significantly.

Conclusion: Despite the high prevalence of consanguinity, there was a low proportion of FDC in the study population. With the prospects of treatment of asymptomatic IDC to slow the progression of the disease, all family members of newly identified IDC patients should receive screening and counselling, with appropriate therapy where indicated.
Plasma and erythrocyte levels of trace elements and related antioxidant enzyme activities in low‐birthweight infants during the early postnatal period
Authors: Oshiro M , Mimura S , Hayakawa M , Watanabe K
Published: August 2010

To discover the relationship between antioxidant enzyme activities and trace elements in low‐birthweight infants during the early postnatal period, we analysed catalase (CAT), CuZn‐superoxide dismutase (CuZn‐SOD) and glutathione peroxidase (GSH‐Px) activities in erythrocytes, and compared them with Fe, Cu, Zn and Se levels in plasma, and Cu, Zn and Se levels in erythrocytes until 16 wk after birth. Thirteen low‐birthweight infants whose mean birthweight and gestation were 1520 ± 293 g and 32.0 ± 2.8 wk were enrolled in this study. All infants were without chronic complications, well nourished, and predominantly fed standard formula or preterm formula based on cow's milk, commercially available in Japan. Cu and Zn levels in erythrocytes did not decline after birth, in contrast to a temporal decrease in plasma Zn. Erythrocyte CAT activity was significantly higher at 16 wk than that at birth or 4 wk of age. Erythrocyte CuZn‐SOD activity did not change throughout the study period. Only Se in plasma and erythrocytes decreased remarkably after birth, which resulted in a significant decline in erythrocyte GSH‐Px activity at 8 and 16 wk (11.2 ± 2.0 and 11.0 ± 1.1 U/g Hb) compared to that at birth (12.4 ± 2.1 U/g Hb).

Conclusion: During the early postnatal period, erythrocyte CAT and CuZn‐SOD activities did not decrease in formula‐fed, low‐birthweight infants. Japanese commercial formula not supplemented with Se, however, caused postnatal plasma and erythrocyte Se deficiency and a concomitant decline in erythrocyte GSH‐Px activity in the same subjects.
Cerebral proton magnetic resonance spectroscopy of neonates after extracorporeal membrane oxygenation
Authors: Rijn AM Roelants‐van , van der Grond J , de Vries LS , Groenendaal F
Published: August 2010

During venoarterial extracorporeal membrane oxygenation the right carotid artery is ligated in a hypoxic neonate. The aim of the present study was to compare the morphology and metabolism of the left and right basal ganglia in 10 neonates after extracorporeal membrane oxygenation, using proton magnetic resonance imaging and spectroscopy. Data could be obtained in 9 neonates. No significant metabolic differences were found between either the left or right basal ganglia, despite a small right‐sided thalamic infarct in one child. Metabolism was normal in all cases. All the infants showed symmetrical neurodevelopment.

Conclusion: Ligation of the right carotid artery for venoarterial extracorporeal membrane oxygenation did not produce persistent changes in brain metabolism in the basal ganglia in this small group of patients.
“Ethnic” variation in childhood lung function may relate to preventable nutritional deficiency
Authors: Mukhopadhyay S , Macleod KA , Ong TJ , Ogston SA
Published: August 2010

This study aimed to define the differences in lung function between British Caucasian and rural eastern Indian children, and to test the hypothesis that nutrition could account for such “ethnic” variation. To exclude confounders, a rural Indian setting was identified and children were screened for respiratory illness before lung function and nutritional characteristics were measured. Regression equations for this population have already been published. In this study, the lung function differences between rural eastern Indian (n= 391) and mean predicted lung function for Caucasian children were characterized, matched for height and sex. In addition, stepwise multiple regression models were fitted to investigate the relative associations of lung function differences with body mass index (BMI), occipitofrontal circumference and age. Although the largest differences in the forced expiratory volume in 1 s (FEV1) [girls 28.7 (27.3‐30.1), boys 23.4 (22.2‐24.6)] and forced vital capacity [girls 27.9 (26.4‐29.4), boys 30.7 (29.6‐31.9)] [values as mean difference in % predicted (95% confidence intervals)] ever reported between two populations were observed, differences in peak expiratory flow rate (PEFR) were small. BMI was strongly associated with inter‐racial differences for FEV1 for both sexes (boys β=−0.227, girls β=−0.353, p≤ 0.001) and PEFR for girls (β=−0.200, p≤ 0.05) (β= standardized coefficient).

Conclusion: Preventable nutritional factors may play a causal role in determining the FEV1 differences between rural Indian and Caucasian children. As peak FEV1 in youth influences respiratory morbidity in later life, it is important to define specific nutrient deficiencies that may relate to poor FEV1 growth in these children.
Association between size at birth, paediatric diarrhoeal incidence and postnatal growth
Authors: Cheung YB , Jalil F , Yip PSF , Karlberg JPE
Published: August 2010

This study tests the hypothesis that size at birth is associated with diarrhoeal incidence from birth to 24 mo of age, and the hypothesis that diarrhoeal incidence from birth to 24 mo is associated with body size at age 24 mo. This is a longitudinal study of 1476 infants born in Lahore, Pakistan, in 1984–1987. Diarrhoeal incidence was enumerated monthly. A generalized estimating equations approach with Poisson regression showed that birthlength standard deviation score (SDS) and ponderal index at birth (rate ratio = 1.01 and 1.00; each p > 0.05) were not significantly associated with diarrhoeal incidence. Multiple linear regression showed that diarrhoeal incidence was significantly associated with weight SDS and body mass index at 24 mo (regression coefficient or β=−0.58 and −1.02; each p < 0.05), but not with height SDS (β=−0.10; p > 0.05). The associations were mainly due to a transient effect of diarrhoea in the period 18–24 mo.

Conclusion: Prevention of low birthweight is unlikely to have an impact on diarrhoeal incidence in infants. Control of diarrhoeal incidence may not improve the growth of infants in developing countries.
Non‐tuberculous mycobacterial lymphadenitis in healthy children: another “lifestyle disease”?
Authors: Eriksson M , Bennet R , Danielsson N
Published: August 2010

An increasing incidence of non‐tuberculous mycobacterial (NTM) lymphadenitis has been reported in previously healthy children in the western world since about 1985. In this study we investigated the sociodemographic and individual characteristics of these patients. Information about patients was collected prospectively from 1977 to 1996. For comparison, an ad hoc group of hospitalized children with bacterial cervical lymphadenitis was chosen. In addition to individual characteristics, information was collected on the country of birth of the patients and their parents, and the socioeconomic characteristics of the domicile area. We identified 81 children with NTM, 14 with tuberculous and 192 with septic lymphadenitis. Significantly more parents of children with NTM than in either of the other two groups were Swedish‐born and lived in privileged socioeconomic areas.

Conclusion: The increase in NTM lymphadenitis in healthy children has taken place at the same time as the reported increase in atopic disease and asthma in childhood. Both groups of patients seem to come from favourable living conditions. It is speculated that NTM lymphadenitis, like asthma and certain other diseases triggered by the immune system, might be a “lifestyle disease”.
Successful treatment of refractory ascites in a child with transjugular intrahepatic portosystemic shunt
Authors: Lee WS , McKiernan PJ , de Ville de Goyet J , Tanner MS , John PR
Published: August 2010

A 16‐y‐old boy who had undergone bone marrow transplantation for relapsed acute lymphoblastic leukaemia developed liver cirrhosis and refractory ascites, which did not respond to salt restriction, diuretics and abdominal paracentesis. Liver transplantation was not feasible because of poor nutritional status, pre‐existing renal dysfunction and uncertainty about the prognosis of his leukaemia. The patient underwent a successful transjugular intrahepatic portosystemic shunt (TIPS), with immediate resolution of ascites, enabling cessation of diuretics and improvement in nutritional status. At 24 mo following TIPS there has been no re‐accumulation of ascites.

Conclusion: TIPS may have a role in the management of refractory ascites secondary to liver cirrhosis in selected children.
Malabsorption of modified food starch (acetylated distarch phosphate) in normal infants and in 8–24‐month‐old toddlers with non‐specific diarrhea, as influenced by sorbitol and fructose
Authors: Lebenthal‐Bendor Y , Theuer RC , Lebenthal A , Tabi I , Lebenthal E
Published: August 2010

Acetylated distarch phosphate (ADiSP) is a modified starch used in some baby foods. The bioavailability of ADiSP and a native (unmodified) starch was evaluated in 20 normal infants and 21 toddlers aged 8–24 mo with chronic non‐specific diarrhea. Formulae contained 8% native or 8% modified waxy maize starch. No infant or toddler consuming Formula N (native starch) had elevated peak breath hydrogen levels (20 ppm or greater), stools clinically positive for reducing substances (0.75% or greater) or loose stools. Fourteen infants received formula M (modified starch): 2 had elevated breath hydrogen, 1 had positive stools and another had loose stools. Of the 21 toddlers fed formula M, 2 had elevated breath hydrogen, but none had positive stools or loose stools. Formula NS (native starch with 2% sorbitol) had little effect on breath hydrogen in the infants but significantly increased it in the toddlers. Formula NS produced loose stools in 2 toddlers but no clinically positive stools in any infant or toddler. Formula MS (modified starch with 2% sorbitol) elevated breath hydrogen in 3 infants and 8 toddlers, and produced positive stools in 2 infants and 2 toddlers, and loose stools in 4 infants and 7 toddlers. Formula MSF (modified starch with 2% sorbitol and 5% fructose) elevated breath hydrogen in 7 infants and 10 toddlers, positive stools in 7 infants and 6 toddlers, and loose stools or diarrhea in 7 infants and 11 toddlers.

Conclusion: ADiSP modified starch can increase breath hydrogen and produce loose stools. Sorbitol and fructose aggravate the malabsorption, in some cases leading to frank diarrhea.
Sodium and water homeostasis in children with shigellosis
Authors: Lindblad H , Berg U , Dhar U , Mahalanabis D , Salaam MA , Zetterström R
Published: August 2010

Studies in Bangladesh have shown that the mortality in shigellosis is significantly higher in hyponatraemic (HN) than in normo‐ (NN) or hypernatraemic children. The aim of this study was to describe the effect of shigellosis on renal haemodynamics and sodium and water homeostasis before treatment was started. Twenty‐one moderately ill children infected with Shigella dysenteriae type 1 were studied. Eight of them had a serum sodium concentration below 130 mmol/L. Renal function was determined by glomerular filtration rate measured by clearances of inulin and iohexol. Effective renal plasma flow was estimated by clearance of para‐aminohippuric acid. Plasma renin, aldosterone and anti‐diuretic hormone were also studied. The HN children had significantly higher haemoglobin and haematocrit levels than the NN group. There was an inverse correlation between serum sodium and haemoglobin, and a direct correlation between serum sodium and urinary sodium and urinary chloride. Direct correlations were found between serum aldosterone and haemoglobin, plasma renin and systolic blood pressure and an inverse correlation between serum aldosterone and serum sodium. Clearances of inulin and iohexol were normal. Detectable levels of ADH were found in both groups, despite low serum osmolalities.

Conclusion: The HN state seems to be triggered by multiple factors. The normal glomerular filtration rate excludes a volume expansion secondary to reduced renal function. Inappropriate or a physiological increase of anti‐diuretic hormone secretion may be of importance. The higher sodium losses in stools of the HN children might also be a factor contributing to the HN.
Real‐time ultrasound‐guided renal biopsy with a biopsy gun in children: safety and efficacy
Authors: Levart T Kersnik , Kenig A , Ponikvar J Buturović , Ferluga D , Čavić M Avguštin , Kenda RB
Published: August 2010

Real‐time ultrasound‐guided renal biopsy (RB) with a biopsy gun has become a standard procedure in the treatment of children. The purpose of the study was to establish the complication rate after real‐time ultrasound‐guided RB with a biopsy gun, the adequacy of renal tissue samples for pathohistological tests, the rate of concurrence between clinical and pathohistological diagnoses, and the benefits of the procedure. From January 1994 to October 1999, 88 renal biopsies were performed on 82 children, 81 of whom (35M, 46F, aged 3‐20 y) were included in this retrospective study. The nephrotic syndrome (in infants, older children, those with evidence of nephritis or failing corticosteroid therapy) was the most frequent indication of RB. Other indications were non‐nephrotic proteinuria, nephritic syndrome, glomerular haematuria, renal allograft dysfunction, unexplained acute or chronic renal failure, and kidney disease progression monitoring. No serious complications were noted. The adequacy rate of renal tissue samples ranged from 93.1 to 96.6%, depending on which definition of the adequacy of renal tissue samples was used. Clinical and pathohistological diagnoses matched in 81.4% of the cases. Data obtained by RB were very beneficial to patients in terms of establishing, confirming or altering the diagnosis and, consequently, the treatment.

Conclusion: The results confirm that real‐time ultrasound‐guided RB with a biopsy gun is a safe procedure and provides information that is very beneficial to patients.
Computerized image analysis of bubbles in gastric aspirate for prediction of respiratory distress syndrome
Authors: Fiori HH , Linderholm B , Fiori RM , Robertson B
Published: August 2010

Gastric aspirates were obtained from 80 newborn babies (gestational age 24–34 wk). Fifteen of these babies developed respiratory distress syndrome (RDS). Bubbles were generated in the samples by vigorous suctioning and the number and size distribution of the bubbles were determined in random fields by computer‐aided image analysis. Sensitivity and specificity for prediction of RDS were 87% and 78% for average diameter of bubbles (cut‐off points >45 μm) and similar for the proportion and total number of microbubbles (diameter <20 μm).

Conclusion: Computerized image analysis of bubbles in gastric aspirate can be used for non‐biased prediction of RDS in newborn babies.
Prevalence and awareness of excess weight in 13 and 14 year olds in Northern Ireland using recent international guidelines
Authors: Yarnell JWG , McCrum EE , Patterson CC , Skidmore P , Shields MD , McMahon J , Evans AE
Published: August 2010

Concern has been expressed in recent years over the rising trends in overweight and obesity, particularly in children in developed countries. No recent data were available for Northern Ireland; therefore measurements of height and weight were included in a study in Northern Ireland originally designed as part of an international study to estimate the prevalence of symptoms of asthma and atopy in childhood. Twenty‐six schools across the province were sampled, 2484 children aged mainly 13 and 14 y completed questionnaires, and 2307 were weighed and measured. Using recently proposed international guidelines on defining overweight and obesity in children the prevalence of overweight in boys was 16%, with 4% being obese. In girls 16% were also overweight and 2% were obese. This concurs with figures for English and Scottish schoolchildren up to 12 y of age from 1994. Less than one‐sixth of obese boys but more than one‐third of obese girls were on weight‐reducing diets (the majority self‐prescribed), reflecting differing attitudes towards excess weight.

Conclusion: In line with figures in younger children from England and Scotland this study shows that 16% of boys and girls from Northern Ireland are classed as overweight using recent international guidelines. Only 15% of obese boys compared with 38% of obese girls stated that they were on weight‐reducing diets.
Sleep habits and sleep problems among a community sample of schoolchildren
Authors: Nevéus T , Cnattingius S , Olsson U , Hetta J
Published: August 2010

Sleep habits, sleep problems and subjective depth of sleep among 1413 schoolchildren aged 6.2‐10.9 y were examined via a questionnaire, answered by the child and parent together. Total sleep time was approximately 10.5 h, with no difference between the sexes. Of 887 children who reported that they were awoken at night, parents considered that 75% were superficial sleepers and 25% were deep sleepers. The prevalence of frequent insomnia, sleepwalking and daytime sleepiness was 13, 7 and 4%, respectively. Logistic regression analyses indicated that onset insomnia was associated with fear of sleeping alone, bone pains, hypnagogic myoclonias, rhythmic movement disorder, enuresis, nocturia, confusion when awoken at night, nightmares, bodily movements during sleep, interrupted sleep, daytime sleepiness and daytime headache or stomach ache. Somnambulism was associated with rhythmic movement disorder, somniloquy, spontaneous confused arousals, nocturia and confusion when awoken at night. Increased risk of daytime sleepiness was found among children with fear of sleeping alone, onset insomnia, rhythmic movement disorder, spontaneous confused arousals, snoring, confusion when awoken, nightmares, bodily movements during sleep and headache or stomach ache.

Conclusion: The results support the notion that onset insomnia is a problem with a predominantly psychological and behavioural background, while sleepwalking is a disorder of arousal without major psychological implications. The mechanisms behind daytime sleepiness seem to be multifactorial.
The Chinese version of the Parenting Stress Index: a psychometric study
Authors: Yeh C‐H , Chen M‐L , Li W , Chuang H‐L
Published: August 2010

This study examined the psychometric properties of a Chinese version of the Parenting Stress Index/Short Form (PSI/SF). A 15‐item simplified PSI/SF (S‐PSI/SF) was subsequently developed which maintained a level of reliability and validity similar to the full version. The Chinese PSI/SF was tested on 149 parents (100 mothers, 49 fathers) of pediatric cancer patients in Taiwan. Psychometric testing was conducted using item analysis, Cronbach's alpha and confirmatory factor analysis. The S‐PSI/SF was constructed based on the item analysis of the PSI/SF. Both the PSI/SF and S‐PSI/SF produced good reliability coefficients. Confirmatory factor analyses indicated that both PSI/SF and S‐PSI/SF met all criteria for goodness of fit. Compared with the PSI/SF, the S‐PSI/SF demonstrated better internal consistency and overall fit at the one‐subscale level, and satisfactory overall fit at two‐ and three‐subscale levels. Despite the limited number of items included, the S‐PSI/SF had a very good factor structure. No gender difference in parenting distress index was observed between mothers and fathers of pediatric cancer patients.

Conclusion: The 15‐item S‐PSI/SF is a brief, easily administered instrument that has evidence of reliability and validity in Taiwanese parents of children with cancer. It could serve as a valuable assessment tool in clinical practice to identify parenting stress with a need for intervention.
Eosinophil counts and urinary eosinophil protein X in children hospitalized for wheezing during the first year of life: prediction of recurrent wheezing
Authors: Øymar K , Havnen J , Halvorsen T , Bjerknes R
Published: August 2010

Early identification of wheezing children with an increased risk of recurrent wheezing or subsequent asthma is important. The aim of the study was to determine the role of markers of eosinophil activation, along with other parameters, in the prediction of recurrent wheezing and allergic sensitization in children with early and severe wheezing. We examined 105 children without atopic dermatitis, hospitalized for wheezing during the first year of life. At a 20‐mo follow‐up, 101 of the children were assessed for the occurrence of recurrent wheezing (at least 3 episodes, including 1 in the previous 6 mo) and allergic sensitization (positive skin‐prick test). By univariate analysis, levels of eosinophil counts at the time of hospitalization (p= 0.005, OR = 18.9), age in months (p < 0.0001, OR =1.5), respiratory syncytial virus (RSV)‐negative disease (p <0.0001, OR = 8.8), parental atopy (p= 0.006, OR = 3.3) and male sex (0.02, OR = 2.7) were all predictive factors for recurrent wheezing at follow‐up. With all parameters included in a multiple regression analysis, RSV‐negative disease was not a predictive factor for recurrent wheezing. A simple model including eosinophil counts ±0.1± 109/L and age had a predictive accuracy of 79%, with only a 6% chance of a child being wrongly predicted as symptomatic. Urinary protein X (‘U‐EPX) was not a predictive factor for recurrent wheezing. When included in a multiple logistic regression analysis, a level of U‐EP ± 100 μg/mmol creatinine was the only parameter with a positive predictive value for allergic sensitization (p= 0.007, OR = 18.9), whereas age, parental allergy or parental asthma were not.

Conclusion: Children with severe wheezing during the first year of life and subsequent recurrent wheezing are characterized by a normal or high eosinophil count in response to viral infections.
Food allergy and atopic dermatitis in low birthweight infants during early childhood
Authors: Hikino S , Nakayama H , Yamamoto J , Kinukawa N , Sakamoto M , Hara T
Published: August 2010

The prevalence rates of food allergy and atopic dermatitis in low birthweight infants were evaluated. In Fukuoka City, Japan, between July 1994 and September 1997, sufficient information including birthweight, gestational age, sex, feeding method and a history of food allergy was obtained from questionnaires at the well‐baby check‐ups of 21766 infants (18 mo of age) and 4378 children (3 y of age). All the children were examined by pediatricians with regard to the existence of atopic dermatitis. The prevalence rate (8.1%) of food allergy in infants with low birthweight (<2500 g) was significantly lower than that (11.2%) in infants with normal birthweight (>2500 g) at 18 mo of age (p= 0.0002). Atopic dermatitis was also observed at a lower prevalence rate (1.2%) in infants with low birthweight than in those with normal birthweight (2.3%) at the same age (p= 0.0041). However, this significance was lost at 3 y of age. Other characteristics including male sex and breast‐feeding showed independent risks for the development of food allergy and atopic dermatitis at both ages.

Conclusion: This study found that low birthweight was significantly associated with a lower risk of both food allergy and atopic dermatitis at 18 mo of age.
Cystic fibrosis‐related diabetes mellitus: clinical impact of prediabetes and effects of insulin therapy*
Authors: Rolon MA , Benali K , Munck A , Navarro J , Clement A , Tubiana‐Rufi N , Czernichow P , Polak M
Published: August 2010

In patients with cystic fibrosis (CF), glucose intolerance preceding diabetes (prediabetes) may have adverse effects on nutritional status and respiratory function, which are reversible after the start of insulin therapy. Respiratory function (forced vital capacity and forced expiratory volume in one second) and body mass index (BMI) were compared retrospectively in a French cohort of 14 patients during the 5y preceding insulin therapy for diabetes and in 14 age‐ and sex‐matched controls with normal oral glucose tolerance tests. In the diabetic group, all three parameters deviated increasingly from the values in the controls; the differences became statistically different during the 6 mo before insulin therapy. The effect was more important in patients for whom diabetes mellitus was diagnosed on the basis of symptoms of hyperglycaemia than in patients for whom it was diagnosed by systematic screening, but still present in the latter. After insulin was started, respiratory function improved and the BMI returned to normal within 1 y. The annual insulin requirement increased from 0.62 during the first year to 1.25 during the fifth year. Glycosylated haemoglobin (HbAIc) values ranged from 6.6 to 7.8%. Only 2 episodes of severe hypoglycaemia were recorded over 42 patient‐years of follow‐up. The insulin regimen most often used was two daily injections of a mixture of short‐ and intermediate‐acting insulin (n= 10) given with an insulin pen.

Conclusion: The clinical status of CF patients who will need insulin therapy deteriorates before the start of insulin. In patients with CF‐related diabetes, with or without fasting hyperglycaemia, insulin therapy improves anabolism and provides good glycaemic control with few severe hypoglycaemic episodes.
A placebo‐controlled trial of low‐dose erythromycin to promote feed tolerance in preterm infants
Authors: Oei J , Lui K
Published: August 2010

The aim of this study was to assess the efficacy of erythromycin, a motilin agonist, in promoting enteral feed tolerance in preterm infants of ±32 wk gestation. Eligible infants were randomized to receive either low‐dose (2.5 mg kg−1 per dose 6 hourly) oral erythromycin ethylsuccinate or placebo for 10 d from the time of the first oral feed. The data from 22 erythromycin and 21 placebo infants were analysed. Birthweights (erythromycin 1216 ± 380 g, placebo 1355 ± 228 g, p= 0.25), gestation (erythromycin 28.6 ± 2.2 wk, placebo 29.3 ± 1.7 wk, p= 0.24) and other clinical variables were not different between the groups. Almost all infants were fed expressed breast milk. Erythromycin infants had significantly fewer episodes of large residual gastric aspirates (>30% of the previous 6 h worth of feeds) over 10 d (erythromycin 1.1 ± 1.9, placebo 3.6 ± 2.2 episodes, p= 0.0007). Infants in the erythromycin group achieved full oral feeds more quickly (6.0 ± 2.3 vs 7.9 ± 3.5 d, p= 0.04). There were no significant differences between the groups with regard to the number of days on total parenteral nutrition or to the time needed to regain birthweight. One enrolled infant from each group died of necrotizing enterocolitis.

Conclusion: Low‐dose erythromycin promoted gastric emptying and feed tolerance in premature infants at a lower gestational age than previously reported. Increased exposure to broad‐spectrum antibiotics may not be free of risk. Further studies are recommended to assess its efficacy in premature infants with established feed intolerance.
Inhaled corticosteroids for maintenance treatment in childhood pulmonary sarcoidosis
Authors: Kiper N , Anadol D , Ouzçelik U , Göçmen A
Published: August 2010

We present our experience with sequential oral and inhaled corticosteroid therapy in childhood pulmonary sarcoidosis. Fifteen children were followed‐up for a mean of 7y. Treatment consisted of oral prednisolone 2mg/kg/d on initial diagnosis. After remission was reached, alternate day therapy with 1 mg/kg was continued. The dose was tapered to a maintenance dose which controlled the activity of the disease. When patients were free of symptoms and had no clinical and laboratory findings, inhaled corticosteriod treatment was started. Relapse treatment consisted of cessation of inhaled corticosteroids and start of oral corticosteroids at a dosage of 2 mg/kg/d and then a tapered dose. Five patients were given oral corticosteroids only. Nine patients were given inhaled steroids after oral corticosteroid therapy had been discontinued. Clinical and radiological remissions were achieved in every patient.

Conclusion: Sequential oral and inhaled corticosteroid therapy may be an alternative treatment regimen for sarcoidosis in children.
Association between maternal pre‐existing or gestational diabetes and health problems in children
Authors: Åberg A , Westbom L
Published: August 2010

There is general consensus that children of women with pre‐existing diabetes mellitus (PDM) have an increased risk of malformations and neurodevelopmental problems. Whether this is also true for children of women with gestational diabetes mellitus (GDM) is a matter of debate. This study investigated inpatient hospital care up to 10 y of age of children born to GDM and PDM women as a rough estimate of child morbidity. Hospital care of children born to 82 684 GDM women, 3874 PDM women and 1213 957 controls was compared by linking the Swedish Medical Birth Registry with the Hospital Discharge Registry. Similar comparisons were performed in a local well‐controlled group of 326 children born to GDM women in the Lund area. Children of PDM women and to a lesser degree children of GDM women had a statistically significant increase in hospitalizations, evident at least up to 10 y of age. Significantly increased risks of hospitalization were found for neurological/developmental disorders [odds ratio (OR) 2.30 and 1.36 for PDM and GDM, respectively)], malformations (OR 2.05 and 1.23), infections (OR 1.56 and 1.20) and accidents (OR 1.32 and 1.14).

Conclusion: The high hospitalization rates of these children indicate an increased morbidity, including neurodevelopmental disorders.
Infantile genetic agranulocytosis, morbus Kostmann: Presentation of six cases from the original “Kostmann family” and a review
Authors: Carlsson G , Fasth A
Published: August 2010

In 1956 Rolf Kostmann reported on six children with severe neutropenia associated with a block in myelopoiesis at the promyelocyte/myelocyte stage and an autosomal recessive inheritance. He named the new syndrome infantile genetic agranulocytosis. Today it is known as Kostmann's syndrome or severe congenital neutropenia. In 1975 an additional 10 cases from northern Sweden were published. This article reports on the only long‐term survivor from the 1975 report plus another five patients born after 1975 who belong to the original “Kostmann family”. Treatment and survival have changed dramatically since Kostmann's first publication. In the pre‐antibiotic era, Kostmann's syndrome was inevitably fatal during the first year of life.

Conclusion: Since the introduction of recombinant human granulocyte colony‐stimulating factor (G‐CSF) about 10 y ago, most patients now enjoy a normal life span and a greatly improved quality of life. Although the threat of death has disappeared, patients still have problems with infections, especially chronic gingivitis and periodontitis. In other groups of severe neutropenia, not related to the original “Kostmann family”, an increased incidence of myeloid leukaemia has been observed. However, in this small cohort none of the children on chronic G‐CSF therapy have developed malignancies.
Danaparoid sodium (Orgaran®) in four children with heparin‐induced thrombocytopenia type II
Authors: Zöhrer B , Zenz W , Rettenbacher A , Covi P , Kurnik K , Kroll H , Grubbauer HM , Muntean W
Published: August 2010

We report on four children with heparin‐induced thrombocytopenia type II. In three patients, therapy with unfractionated heparin was associated with development of cardiac thrombi or with thrombosis progression up to the inferior vena cava or with aggravation of peripheral arterial occlusion. In the fourth child, the disease was recognized early on, and no complication occurred. Heparin‐induced thrombocytopenia type II was confirmed by heparin‐induced platelet activation assay and/or heparin/platelet factor 4‐ELISA. Concomitant elevated antiphospholipid antibodies were seen in all patients. Danaparoid sodium applied at a dosage of between 1.2 and 7.1 U/kg/h stopped the disease progression in each patient. Three children had a clinical recovery with partial recanalization, but for the child with peripheral arterial occlusion disease, amputation of some of the toes became necessary.

Conclusion: Our data indicate that heparin‐induced thrombocytopenia type II is a potential life‐ threatening disease in children and danaparoid sodium is beneficial in this age group.