bluuebunny/crossref_metadata_2025 huggingface dataset:
Highchair accidents
Authors: Mayr JM , Seebacher U , Schimpl G , Fiala F
Published: August 2010

In order to establish guidelines for highchair accident prevention we investigated causes, mode and complications of highchair accidents by the following methods: The charts of 103 children attending our Accident & Emergency department for highchair related injuries were studied retrospectively. Questionnaires were sent to the parents to obtain detailed information about the mode of accident. They were also asked to suggest preventive measures. In addition, a random sample survey was performed with 163 families inquiring about the rate of highchair use and the incidence of highchair related accidents. Of the 103 infants, 15.5% had sustained a skull fracture, 13.6% a brain concussion, 2.0% limb fractures and 68.9% a simple contusion of the head or lacerations to the scalp or face. The questionnaires were fully completed by 61.2% of parents. Every second family reported that their infant had tried to stand up in the highchair before falling off (only one child had been wearing a restraint). In a further 14.3% of accidents the highchair tipped over. Eighty‐seven percent of parents would appreciate a pre‐installation of restraints, 54.0% requested more informative instructions for users, and 33.3% asked for products with better stability. The random sample survey revealed a highchair use rate of 92%; 18% of families used highchairs equipped with restraints, and 6% reported highchair accidents sustained by their children. We conclude that most highchair accidents occur when unrestrained infants try to stand up. Pre‐installed child restraints, better manuals for users and increased highchair stability should be recommended as promising accident prevention strategies.
Intracranial haemorrhage due to factor V deficiency
Authors: Totan M , Albayrak D
Published: August 2010

Factor V deficiency is a rare coagulation disorder which is inherited autosomal recessively. Factor V deficiency should be considered in infants with bleeding disorders and prolonged prothrombin and activated partial thromboplastin times if bleeding continues in spite of vitamin K injection. In this article, the case of an infant with an intracranial haemorrhage due to congenital factor V deficiency is reported.
A huge cystic hygroma of the neck associated with intraventricular haemorrhage in a term neonate
Authors: Yang AD , Chang Y‐L , Chaou W‐T
Published: August 2010

We report on a female term neonate who presented with a huge cystic hygroma of the right neck associated with intraventricular haemorrhage as demonstrated by computerized tomography and magnetic resonance imaging studies. She underwent extraventricular drainage and excision of the neck mass with stable postoperative condition. Psychomotor retardation was found thereafter. To our knowledge, the association of a large cystic hygroma of the neck with intracranial haemorrhage has not been reported previously. The possible mechanism of the occurrence of the haemorrhage is discussed.
In vivo and in vitro studies on the residual allergenicity of partially hydrolysed infant formulae
Authors: Niggemann B , Binder C , Klettke U , Wahn U
Published: August 2010

Aim: Because allergen‐reduced formulae are widely used in the prevention and treatment of cow's milk allergy in children and because anaphylactic reactions have been reported for some hydrolysed formulae, it is of clinical relevance to know about the residual allergenicity of so‐called hypoallergenic formulae. Method: We therefore studied the reactions of 20 children (mean age 1.6 years) with proven cow's milk allergy to a variety of formulae, using skin prick test, specific IgE in serum, protein content and RAST inhibition. Results: Whereas all but two children with a clinically relevant cow's milk allergy had a positive skin prick test to cow's milk, some children still showed positive responses to the partially hydrolysed formulae. No child had a positive skin test to the amino acid formula. Specific IgE to the partially hydrolysed whey formula (median 0.28 U/ml) was significantly lower (p < 0.003) than to cow's milk. Specific IgE to the partially hydrolysed whey/casein formula, soy/pork collagen hydrolysate and the amino acid formula was in a low range (median values 0.19, 0.23 and 0.21 U/ml, respectively. While determination of the protein content of the formulae gave no valid information, RAST/EAST inhibition was highest for cow's milk, followed by the partially hydrolysed whey formula, partially hydrolysed whey/casein formula, soy/pork collagen formula, and the amino acid formula. Conclusion: Skin prick test and RAST inhibition test are suitable methods for determining the residual allergenicity of hydrolysed infant formulae, while determination of protein content using the applied modified Lowry method is not helpful.
Soluble intercellular adhesion molecule‐1 in paediatric connective tissue diseases
Authors: Laucella SA , Gaddi E , Balbaryski J , Giraudi V , Cuttica RJ
Published: August 2010

The intercellular adhesion molecule‐1 (ICAM‐1) is a cytokine‐induced glycoprotein involved in the recruitment of cells into tissues undergoing inflammatory responses. The aim of this study was to compare the levels of soluble ICAM‐1 (s‐ICAM‐1) in children with juvenile chronic arthritis (JCA) and systemic lupus erythematosus (SLE) and to evaluate the usefulness of this molecule as marker of disease activity. Levels of s‐ICAM‐1 were measured in sera using a monoclonal antibody sandwich enzyme‐linked immunoassay. Serum levels (mean ± SD) of s‐ICAM‐1 in 37 children with JCA, 18 patients suffering from SLE and 25 healthy controls were 609 ± 184, 513 ± 139 and 210 ± 95 ng/ml, respectively. A significant difference could be demonstrated between the levels of s‐ICAM‐1 in sera from each disease, as a group, and those of healthy controls. Higher levels of s‐ICAM‐1 were recorded in JCA patients with systemic features and patients who had polyarthritis than in children who were pauciarticular. A positive correlation was observed between s‐ICAM‐1 levels and disease activity score in SLE patients. Moreover, s‐ICAM‐1 levels closely followed clinical conditions in five children with SLE during follow‐up. The data show that s‐ICAM‐1 levels are increased in children suffering from connective tissue diseases and reflect disease status or activity, suggesting the usefulness of this molecule in the follow‐up of these diseases.
Social determinants of birthweight, ponderal index and gestational age in Sweden in the 1920s and the 1980s
Authors: Vågerö D , Koupilová I , Leon DA , Lithell U‐B
Published: August 2010

This study compared the effect of social class and marital status on birth outcomes in Sweden, using (i) data on all births at the Akademiska Hospital in Uppsala from 1920 to 1924 with socioeconomic information from records at birth; and (ii) a linkage of the Medical Births Registry for all births in Sweden in November/December 1985 to the 1985 Census. Preterm births (<37 weeks) have become less common during the 20th century. Between 1920–24 and 1985, mean and median birthweight increased, as did mean ponderal index, indicating a shift to the right of the birthweight and ponderal index distributions. In 1920–24, birthweight and ponderal index were associated with the social class of the household and with the marital status of the mother. Babies of single mothers were lighter and thinner, and had a much greater probability of being born preterm. In contrast, in 1985, maternal marital status (and cohabitation status) had a weaker effect on birthweight and ponderal index. The importance of household social class for ponderal index and preterm birth changed similarly, but its importance for birthweight remained. The mediating mechanism may have changed. Mothers from farming households now gave birth to the heaviest babies (nearly 200 g heavier than those of unskilled workers). Adjustment for a number of factors, including smoking, had a limited effect on these social class differences. In conclusion, biological processes during the foetal period are systematically linked to the social circumstances of the mother, but in a different way in the 1920s and in 1985.
Cardiac involvement in Coffin‐Lowry syndrome
Authors: Massin MM , Radermecker MA , Verloes A , Jacquot S , Grenade Th
Published: August 2010

Coffin‐Lowry syndrome is an X‐linked recessive syndrome of mental retardation, characteristic facies and skeletal anomalies. In one patient with the syndrome, we observed early recurrent episodes of congestive heart failure with intercurrent normalization and the late development of mitral insufficiency due to annular dilation and congenital abnormalities of the valve apparatus. This unusual course of cardiac involvement, the non‐adaptation of the left ventricular contractility to the aggravation of the mitral insufficiency and the postoperative persistence of the ventricular dysfunction, underline the possible role of an associated primary myocardial disease. This clinical observation demonstrates clearly that a mitral valve malformation can occur in patients with the syndrome, but also the role of a dilated cardiomyopathy, which can be secondary to the mitral regurgitation, but is more likely a myocardial disorder occurring as part of the syndrome.
Effect of iodine supply on neonatal thyroid volume and TSH
Authors: Klett M , Ohlig M , Manz F , Tröger J , Heinrich U
Published: August 2010

A cross‐sectional study was performed to prove the correlation between iodine intake and neonatal thyroid volume in a randomized group of 100 mother/newborn pairs. Thyroid volume and iodine excretion were measured by ultrasound and urinary iodine excretion, respectively. Iodine intake and, nutritional and smoking habits were estimated by questionnaire. In 89 mother/child‐pairs the data were complete for all parameters and have been analyzed: 32 mothers substituted with iodine tablets, average dose 175 |ig K‐Iodide/day. Iodine excretion of prenatally iodine‐subsituted newborns increased by 62% whereas neonatal thyroid volume was reduced by 18% compared with the non‐iodine‐supplemented group. Smoker's newborns (n = 8) had a thyroid volume 20% larger than that of newborns of non‐smokers. Neonatal TSH‐screening values remained within normal limits.
Breastfeeding in phenylketonuria
Authors: Motzfeldt K , Lilje R , Nylander G
Published: August 2010

Eighty‐three infants with classical phenylketonuria have been born in Norway since 1979. The treatment of these children is centralized at the National Hospital in Oslo. Seventy‐four have been breastfed in combination with a phenylalanine‐free protein substitute. Dietary treatment was commenced in hospital between 5 and 33 d of age (mean 14 d). Normalization of serum phenylalanine (below 400 μmol/l) took between 1 and 35 d (mean 8 d). The period of breastfeeding lasted from 1 to 16 mo (mean 7 mo). Growth (weight, length and head circumference) fell within the normal range for age on the Norwegian growth chart.
Control of congenital infection with Toxoplasma gondii by neonatal screening based on detection of specific immunoglobulin M antibodies eluted from phenylketonuria filter‐paper blood‐spot samples
Authors: Petersen E , Eaton RB
Published: August 2010

Two ongoing neonatal screening programmes for congenital infection with Toxoplasma gondii are presented. The New England Newborn Screening Programme has included congenital toxoplasmosis since 1986. The test is based on detection of Toxoplasma‐specific immunoglobulin M (IgM) antibodies eluted from the phenylketonuria (PKU) card. The seroprevalence of Toxoplasma IgG antibodies is at present about 13% and the birth prevalence of congenital toxoplasmosis approximately 1 per 10000 liveborn children. The Danish national neonatal screening programme was expanded to include congenital toxoplasmosis from 1 January 1999. The test is also based on detection of Toxoplasma‐specific IgM antibodies eluted from PKU cards. The seroprevalence of Toxoplasma IgG antibodies in pregnant women is around 25% and the birth prevalence about 1 per 3000 liveborn children. The birth prevalence of congenital Toxoplasma infection is within the range of other congenital disorders included in different screening programmes. Neonatal screening is feasible in areas with a low risk of congenital infection where prenatal screening will not be applicable.
Laboratory integration and utilization of tandem mass spectrometry in neonatal screening: a model for clinical mass spectrometry in the next millennium
Authors: Chace DH , DiPerna JC , Naylor EW
Published: August 2010

Clinical and neonatal screening methods using a tandem mass spectrometer are clearly a model for modern laboratory testing in the new Millennium. By the year 2000, more than 1 million blood and plasma samples will have been tested in laboratories throughout the world for a battery of metabolic disorders using a tandem mass spectrometer as the primary analytical device. A tandem mass spectrometer is considered the “ultimate” analytical detector in a variety of biochemical and clinical methods because of its very high accuracy, selectivity, precision, versatility and robust nature. The ability to achieve very high and reproducible sample throughput (∼600 samples/ instrument/24 h) has made this technology cost‐effective for newborn screening. In order to reliably measure markers of inborn errors of metabolism while maintaining low costs and high efficiency, accuracy and quality, much attention needs to be placed on monitoring and maintenance of all components of the entire testing system. These components include specimen collection and sample preparation methods, analysis by LC tandem mass spectrometry, conversion of raw mass spectra (data) into clinically meaningful results (concentration), expert interpretation of these results so that the clinician can be provided with information to facilitate a diagnose, and follow‐up and education so that the maximum benefits of newborn screening translate into prevention of disease symptoms or more effective treatments. Addressing each part of the whole system will produce a quality screening program that will detect a battery of disorders using tandem mass spectrometry with a disease frequency of nearly 1 in 4000 infants.
DNA microarray technology for neonatal screening
Authors: Dobrowolski SF , Banas RA , Naylor EW , Powdrill T , Thakkar D
Published: August 2010

Modern molecular biology, owing much to the Human Genome Initiative, has elucidated many of the genetic mechanisms underlying heritable metabolic disease. While the use of molecular methods has flourished in research laboratories, complexity and cost have limited their utility in newborn screening. Newborn blood cards provide high quality DNA samples able to provide reliable support to highly multiplexed polymerase chain reactions (PCR). New manufacturing processes have reduced the cost of DNA microarray technology to the point where it is a practical tool for population screening. In a single assay, a DNA microarray facilitates the co‐detection of amplification products diagnostic for several genetic diseases. High throughput is achieved with automation at every step, from DNA extraction to detection of hybrids. We suggest that it is both feasible and practical to develop a first‐tier newborn screening protocol based upon multiplex PCR and analysis of amplification products using DNA microarrays. Initial data utilizing the model systems of sickle cell disease, α‐1‐antitrypsin deficiency and Factor V Leiden will be reported.
A fluorogenic allele‐specific amplification method for DNA‐based screening for inherited metabolic disorders
Authors: Matsubara Y , Fujii K , Rinaldo P , Narisawa K
Published: August 2010

Rapidly growing mutation databases for various inherited metabolic diseases raise the possibility of neonatal screening by DNA‐based diagnosis. It is therefore important to develop a simple DNA diagnostic method which is suitable for processing a large number of samples. We have devised an allele‐specific amplification (ASA) method with a fluorogenic probe (TaqMan probe) to detect point mutations. A pairwise PCR amplification with two sets of allele‐specific primers was performed in the presence of the TaqMan probe with real‐time fluorescence monitoring on an ABI PRISM 7700 sequence detector. The difference in the amplification efficiency between two PCR reactions was determined by “threshold” cycles to differentiate mutant and normal alleles. The method, TaqMan‐ASA, does not require post‐PCR processing, thus obviating potential PCR contamination. Since the entire procedure can be carried out in a 96‐well microtiter plate format, it is easy to automate. We successfully applied TaqMan‐ASA to detect a common g727t mutation in Japanese patients with glycogen storage disease type Ia and a prevalent a985g mutation in Caucasian patients with medium‐chain acyl‐CoA dehydrogenase deficiency.
Controlled trial of universal neonatal screening for early identification of permanent childhood hearing impairment: coverage, positive predictive value, effect on mothers and incremental yield
Authors: Kennedy CR ,   on behalf of the Wessex Universal Neonatal Screening Trial Group
Published: August 2010

Object: Congenital bilateral permanent childhood hearing impairment (PCHI) impairs communication skills and, in some cases, mental health and employment prospects. Management of PCHI within the first year of life can alleviate most of its adverse effects. We investigated whether neonatal screening of all babies born in hospital, in addition to the standard Health Visitor Distraction Test (HVDT), would increase the rates of early diagnosis. Methods: Between 1993 and 1996, two teams of four part‐time testers and equipment moved between two pairs of hospitals to achieve four periods with neonatal screening and four without neonatal screening, each of 4‐6 mo duration in each hospital. Babies did or did not undergo neonatal screening dependent on the periods during which they were born. We used a transient evoked oto‐acoustic emissions (TEOAE) test followed, in infants who failed this test, by an automated auditory brainstem response (AABR) test on the same day. We referred babies with positive results for audiological assessment. Results: 53 781 infants were included in the trial, including 25609 born during periods of neonatal screening. The neonatal screen achieved 87% coverage of inborn births, with a false alarm rate of 1.5%, and an overall yield from the screen of 90 cases of bilateral PCHI ≥ 40dB HTL per 100000 target population, equivalent to 80% of the expected prevalence of the condition in the population. Seventy‐one more babies with moderate or severe PCHI per 100000 target population were referred before age 6 mo during periods with neonatal screening than during periods without. Early confirmation and management of PCHI were significantly increased. The false‐negative rate of neonatal screening was significantly lower than that of HVDT screening (4% vs 27%). Conclusions: Neonatal screening is effective in identification of congenital PCHI and may be particularly useful for babies with moderate and severe PCHI for whom early management may have the most benefit.
Neuropsychological follow‐up in neonatal screening: issues, methods and findings
Authors: Berenbaum SA
Published: August 2010

There are several ongoing studies of psychological outcome in children identified through neonatal screening with phenylketonuria, congenital hypothyroidism or congenital adrenal hyperplasia. These studies document the reduction in mental retardation, learning difficulties and behaviour problems associated with neonatal screening. They also describe other behavioural changes resulting from these disorders. Some behavioural changes are transient or preventable with early diagnosis and treatment, whereas some appear to be irreversible, reflecting permanent brain effects of abnormalities associated with the disease. Despite the variety of disorders studied, there are commonalities in approach and issues, including a developmental neuropsychological perspective resulting in behavioural assessments specific to the disorder and its likely manifestations, a recognition that behaviour may change across time in association with brain development and an understanding of the neural mechanisms underlying the behavioural changes. Assessments go beyond IQ, and include specific intellectual abilities, social behaviour, temperament, behaviour problems and identity. Behavioural changes are related to specific characteristics of the disease and its treatment, including the timing of exposure to abnormal hormones and/or neurotransmitters, the severity of the disease, and the age at initiation and adequacy of treatment. These studies provide information about the ways in which hormones and neurotransmitters affect the development and ongoing function of the brain, and an understanding of the ways in which neonatal screening results in improved psychological outcome. They also provide models for psychological follow‐up of other disorders detected through neonatal screening.
Ethical, legal and health economic aspects of neonatal screening
Authors: Riis P
Published: August 2010

The spectrum of the title of this work is wide, but necessarily so, because of the increasing interaction of the three key components–ethics, law and health economy–in all parts of health systems. Although by nature the key components are different, they are still interdependent. Ethics, as the overall term for values, norms and attitudes of democratic societies, is the basic reference for our controlling of our personal lives, our lives with each other, and our lives with society institutions in the broadest sense. Ethics is the cambrium for control with our general behaviour, but is at the same time the cambrium for the control mechanisms of societies, as expressed in national laws. Health economics is often considered a necessary but value‐free part of the spectrum, in accordance with money's very material nature. And yet economics and other resource elements (as organs for transplantation or numbers of special experts) have a strong link to ethics via so‐called distributional ethics (“we are able to do more than we can afford”). The main theme for this introduction is ethics. In neonatal screening it relates to two different aspects: one linked to the neonate as an individual who can benefit from early diagnosis of treatable diseases, the other to the neonate as a member of a family line, enabling geneticists later to use the results for genetic mapping of a whole family or of large societal groups.
The amount of brainstem gliosis in sudden infant death syndrome (SIDS) victims correlates with maternal cigarette smoking during pregnancy
Authors: Storm H , Nylander G , Saugstad OD
Published: August 2010

Brainstem gliosis is elevated in some SIDS victims and has been associated with hypoxicischaemic events. Factors which increase the risk of SIDS include possible risk factors for hypoxic‐ischaemic events during foetal and perinatal life. In this study a scoring system was developed whereby possible risk factors for hypoxic‐ischaemic events during pregnancy, birth and in the perinatal period were correlated with the level of gliosis in the nucleus olivaris inferior in SIDS victims (n= 19). The mothers' antenatal care and obstetric records and the SIDS infants' perinatal hospital records were investigated, and each possible risk factor for hypoxic‐ischaemic events was given one point. The points were summarized for each infant, and this sum was correlated with the level of gliosis in the infant's nucleus olivaris inferior. The number of cigarettes the mothers smoked during pregnancy was also compared with the level of gliosis. Our results show that in SIDS victims there is 41% probability that the more the mothers smoked during pregnancy, the more gliosis in the nucleus olivaris inferior is found in their infants (p < 0.01). Gliosis in the nucleus olivaris inferior also correlated with the possible risk factors for hypoxic‐ischaemic events during pregnancy, birth and the perinatal period (r2= 0.28, p < 0.05). However, if cigarette smoking was excluded as a possible hypoxic‐ischaemic risk factor, no correlation was found.
Short stature in Duchenne muscular dystrophy: a study of 34 patients
Authors: Nagel BHP , Mortier W , Elmlinger M , Wollmann HA , Schmitt K , Ranke MB
Published: August 2010

In Duchenne muscular dystrophy (DMD), short stature is a feature of unknown cause. This cross‐sectional study of 34 male patients (mean age 8.0 y, age range 1.2‐13.7 y) was conducted to examine the relationship between auxological parameters, markers of growth and the extent of muscular weakness. Weight and length at birth (SDS ± SD; 0.0 ± 1.2; 0.2 ± 1.5) and target height SDS (−0.2 ± 0.7) were normal. Height (HT) SDS (−1.0 ± 1.1) was lower than the normal population (p < 0.001) and did not correlate with age. Body mass index SDS (−0.1 ± 1.6) was normal. Tests of insulin‐like growth factor‐I SDS (−0.6 ± 1.2) and insulin‐like growth factor binding protein‐3 SDS (0.1 ± 1.3) ruled out a severe derangement in the GH‐IGF‐axis. The carboxy‐terminal propeptide of type I procollagen (PICP) SDS (0.6 ± 1.5) was normal, but bone‐specific alkaline phosphatase (BAP) SDS (−1.7 ± 0.8) was low (p < 0.001). HT SDS did not correlate with BAP SDS. The Vignos scale, a grading of muscular function (score: 0 = unaffected; 11 = confined to bed) (median (range): 3 (0‐9)) correlated strongly with age (r = 0.77, p < 0.0001), but did not correlate with HT SDS, PICP SDS or BAP SDS. In conclusion, DMD patients are significantly shorter than the normal population, though the HT SDS does not change with age. Growth hormone deficiency does not seem to be the cause of short stature in DMD. Significantly low BAP levels are probably the result of the reduced muscle mass, which leads to a lower biomechanical load on the bone and thus a reduction in bone turnover. The short stature observed in our study is unlikely to be the result of muscular weakness.
Diffuse neonatal haemangiomatosis: new views on diagnostic criteria and prognosis
Authors: Lopriore E , Markhorst DG
Published: August 2010

Diffuse neonatal haemangiomatosis (DNH) is a rare and life‐threatening congenital disorder. An extensive retrospective analysis of the literature was performed to evaluate the clinical features, therapies and prognostic factors of DNH. Reports on 68 patients with DNH were obtained. The skin, liver, lungs, brain and intestine were the organs most commonly involved. Congestive heart failure (CHF) was the primary cause of death. The mortality rate was 77.4% in untreated patients and 27% in treated patients. CHF, Kasabach‐Merritt syndrome (KMS) and the involvement of five or more organs were important risk factors in DNH. The measurement of cardiac output might give more insight into the potential prognostic value of total blood‐volume loss through shunting in the haemangiomas. Reports on 64 patients with neonatal haemangiomatosis limited to only the skin and liver were also obtained. The clinical features and outcome of patients with only cutaneous and hepatic haemangiomas were similar to those of patients with DNH. The inclusion criteria for DNH should be expanded to include similar patients with only cutaneous and hepatic haemangiomas.
Foetal nutrition, foetal growth restriction and health later in life
Authors: Henriksen T
Published: August 2010

Retarded intrauterine growth has been linked to increased risk of perinatal mortality and morbidity, sudden infant death and poorer health later in life. The independent variables used in these studies are mainly neonatal size parameters, such as weight, ponderal index and ratios of head and abdominal measures. These are, in terms of foetal development and growth, crude parameters. This paper discusses the concepts of growth retardation used in most clinical and epidemiological studies. It is again emphasized that small for gestational age (SGA) and intrauterine growth retardation (IUGR) are different concepts. SGA is a size parameter that may or may not reflect restricted foetal growth and is therefore of limited value. Even IUGR, defined as retarded foetal growth rate, may be a too crude a criterion to select foetuses with short‐ and long‐term health risks. Other biophysical measurements, such as foetal blood flow patterns and biochemical parameters, may be helpful in a better selection of these foetuses and infants. Furthermore, different causes of IUGR, e.g. poor maternal nutrition versus insufficient placental function, may not have the same effects on the foetus. The discrepancies in the results of studies on the relationship between IUGR or foetal malnutrition and short‐ and long‐term health risks may be explained by the crudeness of the independent variables used. In the future, research on the biology of the developing human foetus should be more focused in the studies of the relationship between the intrauterine environment and nutrition and risk of poor health later in life.
Optimality of the birth population reduces learning and behaviour disorders and sudden infant death after the first month
Authors: Saugstad LF
Published: August 2010

The weight distribution pattern of all births can be divided into a “skewing to the left” to lower weights and high neonatal mortality, a “skewing to the right” to higher weights (>3500g) and minimum neonatal and postneonatal mortality, and a “symmetrical distribution” with mortality in between. This study was initiated with the hypothesis that a deficit in newborns of more than 3500 g would adversely affect postneonatal death. Higher and rising postneonatal mortality solely attributable to sudden infant death of unknown cause (sudden infant death syndrome; SIDS) was observed in the Nordic countries with a lower proportion of heavy newborns. Minor environmental intervention almost eliminated excess mortality from this cause, supporting raised susceptibility with a depressed birthweight in postneonatal SIDS. This contrasts with classical neonatal low birthweight SIDS, which is stable despite numerous attempts at reduction, supporting a multifactorial aetiology: low maternal age, low education, low socioeconomic status, maternal smoking, infection, etc. The postneonatal SIDS epidemic associated with a deficit in heavy newborns is thought to be a result of changing behaviour in pregnancy: moderate iatrogenic dietary restriction and young women favouring a low‐calorie, low‐fat diet, especially in the third trimester when the foetus is most vulnerable, which delays myelination and somatic growth and renders the infant susceptible to minor morbidity and irregularity. The timing of death and neuropathological findings suggestive of repeated hypoxic episodes in more than 80% of cases of SIDS prior to death support this theory. The similar weight distribution patterns in SIDS and all births in Denmark, the UK and the USA suggest a substantial proportion of the neonates in these countries could be growth‐retarded and at risk of hypoxic episodes in infancy. A few cases, particularly males (sex‐ratio = 1.7), suffer SIDS, the majority survive. Many, mostly males, present minor CNS signs and learning and behaviour problems. The male predominance accords with males more than 500 g higher optimal birthweight than females and susceptibility to a depressed weight at birth. In order to prevent postneonatal dying, SIDS and reduce learning/behaviour disorders it is necessary to raise the proportion of heavy newborns by promoting foetal growth rate equal to the maternal intrinsic rate by eating to one's appetite a balanced diet, favouring a diet high in marine fat, especially in third trimester, in order to ensure maturation of the CNS and prolong gestation, thereby increasing birthweight. Although the increased survival of some very low birthweight neonates confounds the issue, a division between SIDS in neonatal and postneonatal death is recommended in order to assess the proportion of “avoidable infant death” as opposed to persistent classical neonatal SIDS.
Child health and environmental pollution in the Aral Sea region in Kazakhstan
Authors: Zetterström R
Published: August 2010

Environmental pollutants, which may occur in breast milk and in various food products and drinking water, and which are also transferred to the foetus, constitute a severe threat to the health of infants and children. Among such compounds, various organochlorines, such as pesticides for the control of parasites (DDTs, HCHs), and products of industry and agriculture, such as dioxins and dioxin‐like compounds (PCBs), are much discussed, in addition to organic mercury and heavy metals, such as lead and cadmium. The consequences of acute exposure to PCB have been documented in Japan following the ingestion of rice oil contaminated by PCBs. In Sweden birthweight has been found to be reduced and the perinatal mortality rate higher than expected in regions with high consumption of fatty fish from the Baltic Sea. In addition, from studies around Lake Michigan, it has been shown that children who have been exposed to PCBsin uterohave retarded cognitive development. In the Aral Sea basin in Central Asia people have been subjected to long‐term exposure to various pesticides, which have been distributed over the cotton fields in huge quantities. Organochlorines are resistant to breakdown in nature, thus they enter the food chain, eventually entering the human diet, and they may also be inhaled from dust. Such compounds accumulate in the foetus by placental transport and continue to do so postnatally if the infants are breastfed, as they may be present in high concentrations in human milk. The health of children living in the Aral Sea region is reported to be poor, with high morbidity and mortality and a high rate of chronic diseases and retarded mental and physical development. However, in addition to being subjected to environmental pollution, these children also suffer from health hazards related to poverty. Through epidemiological studies it may be possible to obtain information about to what extent exposure to environmental pollution from organochlorines contributes to the poor health of people living in the Aral Sea region.
Prevention and management of food allergy
Authors: Businco L , Bruno G , Giampietro PG
Published: August 2010

The phenotypic expression and natural history of food allergy vary widely according to the patient's age, disease presentation and type of offending food. Prevention of food allergy might be achieved by altering the dietary factors responsible for the sensitization and phenotypic expression of the disease. Owing to the peculiarity of the atopic status, a minute amount of allergens can trigger both sensitization and symptoms in atopic individuals. The oral dose of β‐lactoglobulin causing sensitization can be estimated to be between 1 ng and several milligrams. In food allergy, sensitization and treatment are allergen specific; therefore, for primary prevention (avoiding sensitization) and secondary prevention of food allergy (avoiding symptoms in an already sensitized subject), a product without immunogenic and allergenic epitopes should be given in each case. Babies of atopic parents are particularly prone to develop food allergy and for this reason they are called high‐risk babies. Cow's milk is the most commonly offending food in both gastrointestinal and cutaneous manifestations. Cow's milk proteins are potent allergens and around 2.5% of infants experience cow's milk allergy in the first years of life. The major risk factors for cow's milk allergy are positive family history of atopy and early exposure to cow's milk proteins. Hydrolysate formulae have been developed for the purpose of reducing the allergenicity of cow's milk proteins. More recently, partially and extensively hydrolysed formulae have also been used for feeding babies with a high risk of atopy for the prevention of cow's milk allergy. However, according to the results of a recent randomized controlled study, only an extensively hydrolysated formula, and not a partially hydrolysated formula, significantly decreased the prevalence of cow's milk allergy.
Passive immunity against rotavirus in infants
Authors: Hammarström L
Published: August 2010

Passive immunity against a variety of gastrointestinal infections, using orally administered human antibodies, has been tried in a number of clinical trials. Recently, antibodies from other species such as cows and chickens, which have shown efficacy in experimental animal systems, have also been tried in humans. This review summarizes published data on the use of immunoglobulin‐containing preparations for prophylaxis and therapy against rotavirus infections in infants and children, and directions for their future use are suggested.
Imaging of renal scarring
Authors: Stokland E , Hellstrom M , Jakobsson B , Sixt R
Published: August 2010

Children with urinary tract infection should be investigated and followed up, as those with pyelonephritis may develop renal scarring. In this review, after discussing the advantages and disadvantages of various imaging modalities for diagnosis of renal scarring, it is concluded that DMSA scintigraphy and urography can both be used to detect significant renal scarring. With DMSA scintigraphy, small renal lesions (functional uptake defects) not seen at urography will also be detected. The long‐term clinical significance of these lesions is, as yet, unknown. A normal DMSA scintigraphy after infection indicates low risk for clinically significant damage. In order to allow acute, reversible lesions to first disappear, a follow‐up DMSA examination should not be performed until at least 6 mo after the acute infection. Ultrasonography in isolation cannot be recommended for the diagnosis of renal scarring.
Antibacterial prophylaxis in children with urinary tract infection
Authors: Bollgren I
Published: August 2010

The aim, in conservative management of vesico‐ureteric reflux by antimicrobial prophylaxis, is to prevent recurrent febrile urinary tract infections and consequent renal scarring. However, the effects of this prophylactic strategy are difficult to evaluate, since the required studies comparing children on prophylaxis with controls (without prophylaxis but under careful supervision) are lacking. Furthermore, the optimal length of prophylaxis needs to be defined. Since risk of renal scarring is believed to occur more frequently in young people, and since recurrent urinary infections mainly affect girls, the age and sex of subjects are important in the design of a prophylactic regimen. Nitrofurantoin and trimethoprim are the most common agents used for long‐term, low‐dose antibacterial prophylaxis. Break‐through infections still result from non‐compliance and from development of bacterial resistance, the latter mainly arising with trimethoprim. Few studies of prophylactic drugs are available that adequately define patient materials and include a random allocation to the different agents. Further studies of the effects of alternative prophylactic agents are called for, preferably combined with fresh insight into the ecological impact on the bowel and periurethral floras.
Medical or surgical management for children with vesico‐ureteric reflux?
Authors: Jodal U , Hansson S , Hjälmås K
Published: August 2010

A critical survey of the literature on treatment of children with vesico‐ureteric reflux was carried out in order to create a basis for the new Swedish management policy. There are few studies that meet modern standards of scientific methodology and provide adequate patient numbers. The only large investigations that randomized patients to operative or non‐operative treatment were the Birmingham Reflux Study and the International Reflux Study in Children. In these studies, long‐term outcome of renal status and renal function, as well as the number of recurrent infections, were independent of treatment modality. Although pyelonephritic recurrences were less common in the surgically managed group, this did not influence appearance of renal damage. There is no evidence to indicate clear superiority of either medical or surgical management. Further studies are needed to address such questions as the optimal duration of antibacterial prophylaxis and the effect of a dilating reflux that persists into adulthood.
Protection of the young child's brain: personal observations and thoughts in postwar stress syndrome and in natural catastrophes
Authors: Minkowski A
Published: August 2010

This paper calls attention to the plight of children exposed to various traumas associated with wars and other natural disasters around the world. Little systematic attention has been paid to the mental health needs of child survivors of armed conflict. Our observations since 1968 and experiences around the world suggest that there are significant differences in the degree to which children have been prepared in anticipation of exposure to violence and in interventions applied after their exposure. It is the author's impression that prevention and intervention can be quite powerful when employed in these situations.
Heart risk associated with weight loss in anorexia nervosa and eating disorders: electrocardiographic changes during the early phase of refeeding
Authors: Swenne I
Published: August 2010

Refeeding syndromes with electrolyte aberrations, heart failure and arrhythmias may complicate the nutritional rehabilitation of emaciated patients with eating disorders. Therefore, electrocardiographic (ECG) changes and changes in serum electrolyte concentrations following refeeding were studied in 37 admissions of 32 teenage girls with eating disorders. On admission they were all on a weight‐losing course and weighed 37.0 ± 8.0 kg (mean ± SD) following a weight loss of 14.2 ± 7.2 kg. On ECG recordings there was a prolongation of the QT interval and an increased QT dispersion. Serum concentrations of sodium, potassium and magnesium were with few exceptions normal. Serum concentrations of creatinine were high in relation to the low body weight, indicating protein catabolism. The first 2 wk of refeeding resulted in a weight gain of 1.7 ± 0.2 kg without signs of refeeding syndromes or electrolyte aberrations. QT prolongation and dispersion normalized within the 3 d of refeeding.

It is concluded that oral refeeding of patients with eating disorders and weight loss can be performed efficiently and without causing refeeding syndromes. QT pathology, a consequence of acute starvation and a risk factor for cardiac arrhythmias, normalizes within days. In view of the need to balance adequate refeeding and reduction of QT pathology against the risks of refeeding syndromes the start of refeeding of severely emaciated patients is best performed in a hospital setting where monitoring of ECG and serum electrolytes is possible.
Oral feeding in premature infants: advantage of a self‐paced milk flow
Authors: Lau C , Schanler RJ
Published: August 2010

An earlier study demonstrated that oral feeding of premature infants (<30 wk gestation) was enhanced when milk was delivered through a self‐paced flow system. The aims of this study were to identify the principle(s) by which this occurred and to develop a practical method to implement the self‐paced system in neonatal nurseries. Feeding performance, measured by overall transfer, duration of oral feedings, efficiency, and percentage of successful feedings, was assessed at three time periods, when infants were taking 1‐2, 3‐5, and 6‐8 oral feedings/day. At each time period, infants were fed, sequentially and in a random order, with a self‐paced system, a standard bottle, and a test bottle, the shape of which allowed the elimination of the internal hydrostatic pressure. In a second study, infants were similarly fed with the self‐paced system and a vacuum‐free bottle which eliminated both hydrostatic pressure and vacuum within the bottle. The duration of oral feedings, efficiency, and percentage of successful feedings were improved with the self‐paced system as compared to the standard and test bottles. The results were similar in the comparison between the self‐paced system and the vacuum‐free bottle.

Elimination of the vacuum build‐up naturally occurring in bottles enhances the feeding performance of infants born <30 wk gestation as they are transitioned from tube to oral feeding. The vacuum‐free bottle is a tool which caretakers can readily use in neonatal nurseries.
Pilot study of nebulized surfactant therapy for neonatal respiratory distress syndrome
Authors: Berggren E , Liljedahl M , Winbladh B , Andreasson B , Curstedt T , Robertson B , Schollin J
Published: August 2010

Thirty‐four spontaneously breathing newborns with respiratory distress syndrome (RDS) requiring nasal continuous positive airway pressure (CPAP) and an arterial‐to‐alveolar oxygen tension ratio (a/A PO2) of 0.15‐0.22 were randomized to treatment with nebulized surfactant (Curosurf®) or to serve as controls. All children were first supported by nasal CPAP according to normal clinical routines. Surfactant was administered using a modified Aiolos® nebulizer, and a total of 480 mg was aerosolized in each case. The control group received no nebulized material, but had the same CPAP support. Acid‐base status and a/A PO2 were determined at regular intervals before, during and after surfactant administration. Both groups included in the study were similar with regard to gestational age, birthweight, steroids given before birth, sex and Apgar scores as well as a/A PO2 when entering the study. There were no significant differences between the groups in a/A PO2 1‐12 h after randomization, number of infants needing mechanical ventilation, time on ventilator or CPAP. Two children in the treated group developed bronchopulmonary dysplasia. No side effects of the surfactant therapy were noted.

No beneficial effects of aerosolized surfactant were demonstrated in our trial, contrary to data from animal experiments. This finding probably reflects differences in administration techniques. Our findings do not justify large clinical trials with the same protocol. Further work is needed to optimize delivery of aerosolized surfactant to the neonatal lung in clinical practice.
Altering the NICU and measuring infants' responses
Authors: Slevin M , Farrington N , Duffy G , Daly L , Murphy JFA
Published: August 2010

The aim of the study was to measure the impact of a designated Quiet period on the NICU environment and its influence on the infants' physiological and movement responses. The study group comprised 10 preterm infants on assisted ventilation (mean gestational age 28.7 wk (range 24‐32 wk), mean birthweight 1322 g (range 600‐2060 g), meanage 5.2 d). The environment in which the infants were nursed was altered in terms of reduced light, noise, staff activity and infant handling. The infants' heart rate, blood pressure, oxygen saturation and movement responses were recorded during this Quiet period and compared with a period of Normal activity. When the Quiet period was compared with the Normal period (median values), the NICU environment had significantly altered in terms of Light: Quiet period 3.0 Lux, Normal period 254.5 Lux (p lt; 0.01); Noise: Quiet period 54.0 dB, Normal period 58.0 dB (p < 0.01); Alarm events: Quiet period 491.5 sec, Normal period 1180.5 sec (p<0.01); Staff conversation: Quiet period 16.0 occasions per hour, Normal period 60.0 occasions per hour (p < 0.01); Staff activity: Quiet period 25.5 occasions per hour, Normal period 59.0 occasions per hour (p < 0.01); Infant handling: Quiet period 0.0 events per hour, Normal period 4.5 events per hour (p < 0.01). Infants' diastolic blood pressure and mean arterial pressure: median reduction of 2 mmHg for both during the Quiet period (p<0.05). Infants' movements: Quiet period 14.5 movements per hour, Normal period 84.0 movements per hour (p < 0.05).

Discussion: This study demonstrates that Quiet periods are feasible for infants undergoing neonatal intensive care. The NICU environment was altered significantly for light, noise, infant handling and staff activity for a specified time period. These changes were associated with a reduced median diastolic blood pressure and mean arterial pressure and a decrease in infant movements.