bluuebunny/crossref_metadata_2025 huggingface dataset:
Randomized, controlled, blinded trial of doxapram for extubation of the very low birthweight infant
Authors: Barrington KJ , Muttitt SC
Published: August 2010

The objective of the study was to determine whether administering doxapram by infusion to the very low birthweight infant, prior to extubation during the first 3 weeks of life, would increase the incidence of successful extubation. The study patients, 56 infants of less than 1251 g birthweight and less than 30 weeks' gestation, were entered in the first 3 weeks of life when lung disease had started to improve. A randomized blinded trial was performed, with infants receiving 3.5 mg kg−1 doxapram bolus, followed by an infusion at 1 mg kg−1 h−1, or placebo. Weaning from positive pressure ventilation was standardized and extubation occurred after a 12 h trial of an intermittent mandatory ventilation (IMV) rate of 6 breaths min−1, if PCO2 < 55 mmHg, pH > 7.26, and FiO2 < 0.45. Study drug was continued for 48 h postextubation, and the infants were placed on nasopharyngeal continuous positive airway pressure (CPAP) for 72 h postextubation. Extubation failure within the first 72 h after extubation was objectively defined in terms of acidosis (pH < 7.26), hypercarbia (PCO2 > 55 mmHg), excessive oxygen requirement (FiO2 > 0.8) or frequent apnoea (more than three in 12 h, or more than two requiring face mask IMV in 24 h). No difference was noted in the frequency of successful extubation between the groups. Fifteen infants in each group were successfully extubated before the 10th day of the study. In conclusion, when given in accordance with this protocol doxapram does not increase the likelihood of successful extubation in the very low birthweight infant. Increasing successful extubations in this group of infants will require other strategies.
Drug prescribing for children in general practice. A report from the Møre & Romsdal Prescription Study
Authors: Straand J , Rokstad K , Heggedal U
Published: August 2010

To investigate general practitioners' drug prescribing patterns for children (0–12 y), an observational, cross‐sectional study was conducted in Western Norway. Seven thousand, two hundred and twenty‐nine GP‐patient contacts during which 5222 drugs were prescribed, were included for analysis. The highest prescribing rates were for boys <2y (82.1 prescriptions per 100 contacts). Two‐thirds of all prescriptions were for drugs in main groups respiratory system or systemic antiinfectives. The 20 most commonly prescribed agents comprised 75% of all prescriptions. The 20 most frequently recorded diagnoses for prescribing comprised 81% of all. Phenoxymethylpenicillin was the most frequently prescribed antibiotic for otitis, tonsillitis and sinusitis, while erythromycin was used most often for bronchitis and pneumonia. Antibiotics were prescribed in more than 8/10 contacts for tonsillitis, sinusitis, acute bronchitis and pneumonia, and in two‐thirds of all contacts for urinary tract infections. Sixty‐five percent of the antibiotic prescriptions for urinary tract infections were for co‐trimoxazole.
The Mpl ligand and platelet homeostasis
Authors: Nichol JL
Published: August 2010

The classification of Mpl as a cytokine receptor present on cells of the platelet lineage has led to the identification and cloning of its ligand. This has resulted in a rapid accumulation of data advancing the understanding of the processes of megakaryopoiesis and thrombopoiesis and the regulation of endogenous Mpl ligand (thrombopoietin, eTPO). Highlights of in vitro human and non‐human primate data will be discussed, as well as preclinical (in vivo) non‐human primate studies. Two recombinant forms of Mpl ligands (rTPO) are currently being tested in clinical trials and early results will be reviewed. The preclinical and clinical studies will be summarized with consideration of the observations which provide insights into the biology of the response to exogenous rTPO. Understanding the biology of platelet production and the condition of target cells in treatment populations will facilitate the appropriate use of this potential therapeutic agent.
Role of the T cell receptor in idiopathic thrombocytopenic purpura (ITP)
Authors: Hedlund‐Treutiger I , Wahlström J , Elinder G
Published: August 2010

During the past few decades a number of studies has described T cell defects and attempted to elucidate their role in the pathogenesis of idiopathic thrombocytopenic purpura (ITP). Some studies implicate T cells as potential initiators of autoantibody production in ITP. However, only a few of these have studied the role that the T cell receptor may play in the pathogenesis of ITP. In a variety of autoimmune syndromes interest has focused on the α‐ and β‐chains of the T cell receptor. Deviations from the normal T cell receptor gene usage have been reported in rheumatoid arthritis, systemic lupus erythaematosus and multiple sclerosis. Usually, these studies have shown a restricted heterogeneity of T cell receptor variable gene usage. The studies on the T cell receptor in ITP have included a limited number of patients, which makes it difficult to evaluate the significance of the role that the T cell receptor may play in the pathogenesis of ITP. Further studies are warranted.
Reticulated platelet counts in the assessment of thrombocytopenic disorders
Authors: Saxon BR , Mody M , Blanchette VS , Freedman J
Published: August 2010

Reticulated platelets (RP) are the youngest platelets in the circulation and can be measured by analysing the RNA content of platelets from whole blood or platelet‐rich plasma by flow cytometry. Increased RP are indicative of increased production of platelets. Despite the current lack of standardization for the measurement of RP, it is useful in the assessment of patients with ITP by aiding the distinction of these patients from those with decreased platelet production. RP counts also have a role in the assessment of the complicated patient with multiple possible aetiologies for thrombocytopenia. Measurement of the RP count may hold predictive value for marrow recovery following myelosuppressive or myeloablative chemotherapy, and may play a role in monitoring the administration of the various thrombopoietins currently under clinical trial.
Practical management of diabetic ketoacidosis in childhood and adolescence
Authors: Silink M
Published: August 2010

Diabetic ketoacidosis results from insulin deficiency and insulin resistance and is marked by hyperglycaemia, ketoacidosis, dehydration and electrolyte losses. Management includes correction of shock, dehydration, electrolyte deficits, hyperglycaemia, acidosis and sepsis (if present). Warning signs include severe dehydration, shock, pH <7.0, hypokalaemia, hypernatraemia, hyperosmolality, hyperlipidaemia, deterioration in consciousness and diabetic ketoacidosis in very young patients. The principles of treatment include (i) admission to a unit with paediatric experience, (ii) treatment of shock, (iii) rehydration over 24‐36 h, or longer if the osmolality is >360 mmoll−1, (iv) normal saline for rehydration unless the patient is hypernatraemic, (v) avoidance of bicarbonate unless acidosis is interfering with myocardial contractility, (vi) insulin infusion to achieve a fall in blood glucose levels of 5 mmol h−1, (vi) potassium, (vii) use of 5% glucose when the blood glucose level falls <12 mmol 1−1, (ix) treatment of any complications and (x) change to subcutaneous insulin when diabetic ketoacidosis is controlled.
FISH analysis in patients with clinical diagnosis of Williams syndrome*
Authors: Elçioglu N , Mackie‐Ogilvie C , Daker M , Berry AC
Published: August 2010

Williams syndrome is a rare neurodevelopmental disorder with variable phenotypic expression and a contiguous gene syndrome caused by deletion of the elastin gene. In our study, hemizygosity at the elastin locus was investigated using FISH analyses in 16 sporadic cases with a firm clinical diagnosis of Williams syndrome, and the characteristic features were evaluated. Fourteen patients were found to have deletions; 2 further patients did not have deletions of the elastin gene, but did have the clinical features. The presence of two copies of the elastin gene locus in a patient does not rule out Williams syndrome as a diagnosis. Since deletion of the elastin gene, which continues to be a useful confirmatory diagnostic test, cannot account for several features found in Williams syndrome, the non‐deletion patients will be valuable in further delineation of the critical region responsible for the Williams syndrome phenotype.
Decreased trabecular bone mineral density in patients with phenylketonuria measured by peripheral quantitative computed tomography
Authors: Schwahn B , Mokov E , Scheidhauer K , Lettgen B , Schönau E
Published: August 2010

The bone mineral density (BMD) of 14 children, adolescents, and adults with phenylketonuria (PKU) on dietary treatment (age 5–28 y; 6F, 8M) was investigated using peripheral quantitative computed tomography (pQCT) of the distal radius. BMD of total (TBMD) and spongy bone (SBMD) were compared to those of healthy gender‐, age‐, weight‐ and height‐matched controls. We found a significant decrease of SBMD in patients with PKU while TBMD was only slightly decreased, reaching no statistical significance. These results indicate minor changes of BMD in patients with PKU under treatment, which are more accentuated in the trabecular bone compartment. One additional patient who was untreated until the pQCT investigation at the age of 10 y also showed markedly decreased SBMD and TBMD.
Beneficial effect of bisphosphonate during five years of treatment of severe osteogenesis imperfecta
Authors: Åström E , Söderhäll S
Published: August 2010

We report results of 2–5 y treatment with intravenous disodium pamidronate (APD) in three girls with severe osteogenesis imperfecta (OI). Treatment was given as monthly infusions. Additional oral 1,25‐dihydroxy‐cholecalciferol was given to compensate for a transient decrease in serum calcium levels. During treatment, DEXA measurements showed a gradual increase in bone density in all patients. All parameters analysed in serum (ALP, osteocalcin, PICP, ICTP) and in urine (deoxypyridinoline and pyridinoline) showed a decreased bone turnover. The two younger patients reported a major improvement in well‐being, pain and activities of daily life. The effect on the older patient was less pronounced. No negative side effects in clinical or laboratory variables were observed. This study indicates that APD is of value in the symptomatic treatment of children with severe OI.
A case of neonatal haemochromatosis
Authors: Oliveira MG , Fernandes A , Silva AC , Moreira R , Azevedo A , Da Silva LJ
Published: August 2010

We describe a case of neonatal haemochromatosis, pointing out the difficulties in diagnosing this fatal disease, which here involved the early occurrence of hepatic carcinoma.
Secular trends in breastfeeding and parental smoking
Authors: Haug K , Irgens LM , Baste V , Markestad T , Skjærven R , Schreuder P
Published: August 2010

To explore the association between smoking and breastfeeding, we obtained data from a retrospective questionnaire‐based national survey comprising a random sample (n= 34 799) of all mothers giving birth in Norway 1970‐91. Variables studied were postpartum smoking habits for both parents, duration of breastfeeding, infant's year of birth and parental age. The response rate was 70% (n= 24 438). During the study period, the maternal postpartum smoking prevalence decreased from 38% to 26%. The proportion breastfeeding at 6 months increased from 15% to 44% among smokers, and from 30% to 72% among non‐smokers. In spite of a considerable increase in breastfeeding both among smokers and non‐smokers, the proportion of breastfeeding, non‐smoking women at 6 months was twice that of smoking women during the whole period. Furthermore, the duration of breastfeeding was shorter among young mothers and when the fathers were smoking. There was epidemiological evidence that the effect on breastfeeding of smoking might represent both biological and social mechanisms.
Port‐A‐Cath usage in children with haemophilia: experience of 53 cases
Authors: Ljung R , van den Berg M , Petrini P , Tengborn L , Scheibel E , Kekomäki R , Effenberger W
Published: August 2010

Experience of the Port‐A‐Cath implantable venous access system in 53 children with severe or moderate haemophilia A or B from seven centres in five countries is reviewed. The cumulative duration of follow‐up was 1578 months (median 30 months, range 1‐114). Of the devices implanted, 70% (37/53) were used without complications (median follow‐up 32 months; range 1‐114) and the remaining 30% (16/53) were associated with various types of complication: infection, bacteraemia or septicaemia in 56% (9/16) of cases, i.e. a rate of 0.07 per follow‐up year or 0.19 per 1000 patient days, or various technical complications occurring after a median of 32 months (range 4–75) of uncomplicated use in the remaining 44% (7/16). Of the patients with inhibitors, 64% (7/11) manifested complications. Both doctors and parents considered that the Port‐A‐Cath device can be used with an acceptable frequency and severity of complications, and that it enables regular prophylactic or on‐demand home treatment of children with haemophilia to be begun at an early age.
Control of an outbreak of a highly beta‐lactam‐resistant Enterobacter cloacae strain in a neonatal special care unit
Authors: Finnström O , Isaksson B , Hæggman S , Burman LG
Published: August 2010

Two successive outbreaks of colonization and infection with Enterobacter cloacae resistant to third generation cephalosporins (cephalosporin‐resistant E. cloacae, CREC) and involving 15 infants occurred within 12 months in a neonatal special care unit. Isolates of clinical significance were obtained from four infants (urine 2 cases, blood, pleural drainage). According to epidemiological typing using computerized biochemical fingerprinting and pulsed‐field gel electrophoresis (PFGE) the same CREC strain was found in both outbreaks. The origin of the strain and its reservoir between the two outbreaks remained unknown. Emphasizing strict barrier nursing of the infants had little or no impact on the presence and transmission of the strain in the unit. In contrast, replacing ampicillin plus cefotaxime as standard empiric therapy with penicillin G plus netilmicin plus consequent cohorting of newborns and staff promptly halted both the outbreaks. During a 5‐y follow‐up after the last episode, the choice of antibiotics for empirical treatment has varied, and no further outbreaks of CREC have been seen, with the exception of two sporadic cases.
Mental retardation in Norway: prevalence and sub‐classification in a cohort of 30 037 children born between 1980 and 1985
Authors: Strømme P , Valvatne K
Published: August 2010

Objectives: We wanted to determine the prevalence and subcategories of mental retardation (MR) defined as IQ ≤ 70 in Akershus county, which rated by average yearly income, had the second highest socioeconomic status (SES) in Norway. Methods: The study population consisted of 30 037 children born between 1980 and 1985. Cases were ascertained from multiple sources and psychometrically assessed, predominantly with the Wechsler tests, which were standardized in Norway in 1978. The cases were divided into four groups: profound (IQ <20), severe (IQ 20‐34), moderate (IQ 35‐49), and mild (IQ 50–70) MR, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM‐IV). The median age was 10.8 y. The frequency and degree of parental consanguinity were registered, and the average inbreeding coefficient was calculated. Results: Altogether, 185 had IQ ≤ 70, giving a prevalence of MR of 6.2/1000. Prevalences for profound, severe, moderate, and mild MR were 0.8, 0.4, 1.5 and 3.5/1000, respectively. In two, possibly three, cases the parents were second cousins, giving an average inbreeding coefficient of 20‐30 × 10‐5. Conclusions: The low prevalence of MR, particularly mild MR, could partly be explained by high SES, old standardization of IQ‐test, and low inbreeding coefficient. The proportion of profound MR was considerably higher than estimated by DSM‐IV.
Tension pneumopericardium in a preterm infant without mechanical ventilation: a rare cause of cardiac arrest
Authors: Heckmann M , Lindner W , Pohlandt F
Published: August 2010

A preterm infant with a gestational age of 32 weeks developed a tension pneumopericardium during the second day of life. The infant was treated with nasal continuous positive airway pressure and was not mechanically ventilated before pneumopericardium occurred. After emergency pericardiocentesis, two recurrences of pneumopericardium without clinical deterioration were diagnosed by X‐ray during a 2‐d observation period. A continuous pericardial drainage was positioned and was successfully removed on the seventh day of life after weaning from the ventilator. Tension pneumopericardium may occur even in non‐ventilated newborns and should be considered as a rare but important differential diagnosis of cardiac arrest.
Endothelin‐1, atrial natriuretic peptide and pathophysiology of pulmonary hypertension in porcine meconium aspiration
Authors: Soukka H , Jalonen J , Kero P , Kääpä P
Published: August 2010

To evaluate the role of endothelin‐1 (ET‐1) and atrial natriuretic peptide (ANP) in the development of meconium aspiration‐induced pulmonary hypertension, plasma ET‐1 and ANP levels were measured serially for 6h after meconium instillation in juvenile pigs. Eleven 10‐week‐old, anaesthetized and catheterized pigs received intratracheally a bolus of 3 ml kg‐1 20% human meconium, and five of them were premedicated with 30 mg kg methylprednisolone i.v. Another six pigs served as controls and were given 3 ml kg‐1 sterile saline intratracheally. Meconium instillation resulted in an increase in plasma ET‐1 levels with a significant correlation to the simultaneously increasing PVR (r= 0:72). Methylprednisolone had no effect on the early (0‐1 h) ET‐1 increase, but prevented significantly the second phase (1–6 h) rise with a concomitant attenuation of the progressive pulmonary hypertension. ANP concentrations were higher in the meconium than in the control group throughout the study and further increased after steroid treatment with a good correlation to ET‐1 (r= 0:86). Thus, the postinjury rise in circulating vasoactive peptides, together with the pulmonary hypertensive response, and modulation of the peptide balance and pressor reaction by steroids, suggest a contributory role for ET‐1 and ANP in the development of pulmonary hypertension after meconium aspiration.
Enterovirus‐associated haemophagocytic syndrome in a neonate
Authors: Barre V , Marret S , Mendel I , Lesesve JF , Fessard Cl
Published: August 2010

A 3‐d‐old neonate presented with fever, hepatosplenomegaly, coagulopathy, thrombopenia and anaemia. Secondary haemophagocytic lymphohistiocytosis was suspected, as persistent cytopenias were associated with hypofibrinogenaemia, haemophagocytosis in bone marrow and decreased NK cell. There was no positive family lymphohistiocytosis history or parental consanguinity. Bacterial investigation proved negative. The diagnosis of enterovirus maternofoetal infection was carried out. The infant's condition improved with symptomatic therapy from day 7. Follow up at 1 y was normal without relapse. This is the first report of a neonatal enteroviral infection that was responsible for excessive macrophage activation.
Three‐year data from a comparative study with recombinant human growth hormone in the treatment of short stature in young children with intrauterine growth retardation
Authors: Fjellestad‐Paulsen A , Czernichow P , Brauner R , Bost M , Colle M , Lebouc JY , Lecornu M , Leheup B , Limal JM , Raux MC , Toublanc JE , Rappaport R
Published: August 2010

Growth acceleration and bone maturation were studied for 3 y in 69 children with severe short stature and a history of intrauterine growth retardation (IUGR), to determine the effect of treatment with recombinant human growth hormone (r‐hGH). The patients were enrolled in an open, multicentre trial and were randomly allocated to either the treated group (Group 1) or the control group (Group 2). The children in Group 1 were treated daily with 0.2 IU/kg/body weight (0.067 mg/kg) s.c, during 3 y and the children in Group 2 started the study with a 1‐y observation period followed by a 3‐y treatment period. At birth, their mean weight standard deviation score (SDS) was ‐2.5 and their mean length SDS ‐3.5. At baseline, the patients were prepubertal, non‐GHdeficient, with no known dysmorphic features. Mean age was 4.5 y, bone age was 3.3 y, height SDS was ‐3.4, height velocity (HV) SDS was ‐1.6, and body mass index SDS was ‐1.4. After 1 y of treatment, linear HV in Group 1 increased in comparison with the pre‐treatment period (from 5.7 ± 2.0 to 10.1 ± 1.7cm/y;p < 0:001)and with the firstyear of observation in Group2(p < 0:001). Increased HV was sustained during the second and third year of treatment and was significantly higher than at baseline. A similar growth pattern was seen during the 3y of GH treatment in Group 2. Mean height SDS for chronological age increased by 2.0 ± 0.7 in the two groups after 3 y of treatment. HV after 1 y of treatment was negatively correlated with growth velocity at baseline. Bone age remained retarded but increased with a mean of almost 4 y after 3y of treatment in both groups. Even at a dose that is three times the replacement dose treatment with r‐hGH was well tolerated. From these results, we conclude that r‐hGH treatment over 3 y can induce sustained catch‐up growth in young children with severe short stature and a history of IUGR. Long‐term studies are needed to assess ultimate effects on final height.
Effects of a proton‐pump inhibitor in cystic fibrosis
Authors: Tran TMD , Van den Neucker A , Hendriks JJE , Forget P , Forget P‐Ph
Published: August 2010

Most children with cystic fibrosis (CF) show persisting steatorrhoea even when treated with pancreatic enzyme. As a low duodenal pH could be responsible for this persisting fat loss, we evaluated the effects of a proton‐pump inhibitor (lansoprazole) on both steatorrhoea and growth parameters in 15 CF patients, aged 3.1–22.6y. Acid steatocrit, anthropometry and dual‐energy X‐ray absorptiometry were used to evaluate steatorrhoea and the nutritional status before, during and 3 months after stopping lansoprazole treatment (15mg/d for 3 months). Mean ± SD acid steatocrit values decreased from 37.1 ± 8.8% to 28.5 ± 10.6% (p = 0:02). Significant mean Z‐score improvements were found for weight (+0:14; p= 0:02), height (+0:15; p= 0:03), subscapular (+0:61;p= 0:003), supra‐iliac (+0:8; p= 0:002) and the sum of the four measured skinfolds (+0:61; p= 0:002). Z‐scores deteriorated again after stopping lansoprazole. Fat mass and bone mineral content increased significantly on lansoprazole (p= 0:008 and p= 0:005, respectively). We conclude that lansoprazole as adjuvant therapy significantly improves both steatorrhoea and the nutritional status in CF children who maintain steatorrhoea while on pancreatic enzymes.
Molecular genetics of nocturnal enuresis: clinical and genetic heterogeneity
Authors: von Gontard A , Eiberg H , Hollmann E , Rittig S , Lehmkuhl G
Published: August 2010

Forty‐two children with nocturnal enuresis (27 with primary, 4 with secondary nocturnal enuresis and 11 with combined primary nocturnal enuresis and daytime wetting) were selected retrospectively from a study of 167 consecutive children with enuresis. The aim of the study was to collect formal genetic data, perform molecular genetic linkage‐analyses with five microsatellite markers on chromosomes 13q, 12q or 8q and specify the associations between genetic findings and clinical, as well as psychiatric diagnoses. Positive linkage of nocturnal enuresis to one of the microsatellite markers was possible in 27 children from 23 families and was not possible in 15 children. Somatic findings in both the groups with and without possible assignment of nocturnal enuresis to a marker were heterogeneous. Psychiatrically, a low rate of behavioural problems was apparent. These findings support the hypothesis of genetic and phenotypical heterogeneity of nocturnal enuresis, without linkage of specific psychiatric and somatic phenotypes to certain chromosome markers.
Colchicine for recurrent pericarditis in children
Authors: Yazigi A , Abou‐Charaf LC
Published: August 2010

The incidence of recurrence of acute pericarditis in children varies from 15% to 30% and is accompanied by a high morbidity. Various treatment modalities have been used with variable success rates and side effects. La Serna et al. (Lancet 1987; 26: 1517) were the first to treat adults with recurrent pericarditis with colchicine, and were followed by other authors. To our knowledge no studies in children have been reported. In this paper, we present three children who suffered from viral or idiopathic recurrent pericarditis, despite multiple courses of non‐steroidal anti‐inflammatory drugs (NSAIDs) and/or corticosteroids. They responded remarkably well to colchicine, which was administered for 6 months with no adverse reactions. They continue to do well 18, 11 and 12 months after cessation of treatment, respectively.
Nutritional status and diarrhoeal pathogen in hospitalized children in Bangladesh
Authors: Dewan N , Faruque ASG , Fuchs GJ
Published: August 2010

We studied the relationship between nutritional status and infection due to specific enteropathogens in young children with diarrhoea. Overall, 26% of the children were severely underweight, 27% were severely wasted and 19% were severely stunted. Children with Shigellae and V. cholerae O1 were significantly more severely underweight, wasted and stunted than those with rotavirus diarrhoea (p < 0:0001). Our results indicate that an effective nutrition programme for young children might have greater impact on diarrhoeal illness caused by Shigella and V. cholerae than by rotavirus diarrhoea.
Speech and language skills in children who required neonatal intensive care. I. Spontaneous speech at 6.5 years of age
Authors: Jennische M , Sedin G
Published: August 2010

Spontaneous speech at age 6.5 years was studied separately in a follow‐up of speech and language skills in a regional cohort of 284 children requiring neonatal intensive care and in 40 controls. Eight aspects of spontaneous speech were evaluated in a conversation: A1, information; A2, speech motor function; A3, sound pattern; A4, word finding; A5, word selection; A6, grammar; A7, interaction; and A8, motivation. The children were grouped by gestational age. Most children had well developed spontaneous speech. The different groups showed very few differences in types of deviations in spontaneous speech. All groups differed from the controls in speech motor function and formal language (A2‐A6), but only one child, born at <32 weeks, had a pronounced deviation in one of these aspects. Obvious deviations in one or more aspects of spontaneous speech were more common among children born at 28‐31 weeks and in those born fullterm (>37 weeks) than among extremely preterm children born at 23–27 weeks.
Sarcoidosis in children. Epidemiology in Danes, clinical features, diagnosis, treatment and prognosis
Authors: Milman N , Hoffmann AL , Byg K‐E
Published: August 2010

This paper reviews current knowledge of childhood sarcoidosis with regard to the epidemiology in Danes, clinical presentation, diagnostic procedures, treatment and prognosis. Sarcoidosis is a granulomatous disease of unknown aetiology, with multiorgan involvement. The diagnosis is confirmed by the demonstration of epitheloid cell granulomas in tissue biopsy specimens. During the period 1980‐92, three cases of childhood sarcoidosis were recorded in Copenhagen County, which has a total population of 610,000. The approximate incidence of clinically recognized sarcoidosis in Danish children younger than 15 y of age was 0.22–0.27/100,000 children per year, corresponding to approximately three new cases in Denmark each year. The true incidence is unknown, since the disease is often asymptomatic and resolves without a clinical diagnosis being made. In children younger than 5 y of age, the disease is characterized by involvement of skin, eyes and joints, whereas in older children involvement of lungs, lymph nodes and eyes predominate. The mainstay of treatment consists of oral corticosteroids. The risk/benefit ratio of using long‐term corticosteroids needs to be evaluated in each individual patient. Some patients may benefit from additional therapy with methotrexate. The long‐term prognosis is not well established, but it seems to be poorer in children younger than 5y. Older children appear to have as favourable a prognosis as young adults.
Clinical application of the measurement of cord plasma lactate and pyruvate in the assessment of high‐risk neonates
Authors: Chou Y‐H , Yau K‐I Tsou , Wang P‐J
Published: August 2010

Lactate levels in combination with lactate/pyruvate (L/P) ratio have been used to measure altered cellular redox states. We measured the cord plasma lactate levels and L/P ratios in 70 normal neonates (40 full‐term and 30 preterm neonates) to set up the normal (control) ranges. The control cord plasma lactate levels and L/P ratios were 2660 [700 (SD)] μmol/l, 16 (3) in full‐term neonates and 2750 (740) μmol/l, 17 (3) in preterm neonates, respectively. We also measured the lactate levels and L/P ratios in the high‐risk full‐term (n= 23) and preterm (n= 35) neonates, the results were 4500 (2600) μmol/l,19(13), and 5100 (2700) μmol/l,26 (12), respectively. With the aid of elevated lactate levels and L/P ratios, the occurrence of neonatal encephalopathy can be predicted with a sensitivity of 100% and a specificity of 94.5% in this patient group. In our study, the six cases with abnormal neurodevelopment at 6–9 months of age all had both elevated lactate levels and L/P ratios at birth. We conclude that the measurement of lactate levels in combination with L/P ratios is a useful quantitative tool in assessing the existence and severity of perinatal hypoxia in the high‐risk neonates.
Alleviation of the pain of venepuncture in neonates
Authors: Larsson BA , Tannfeldt G , Lagercrantz H , Olsson GL
Published: August 2010

A recent study has shown venepuncture to be more effective and less painful than heel‐lancing when a single blood test is performed in neonates [Larsson, Pediatrics (in press)]. The aim of the present study was to investigate the value of EMLA applied on the dorsum of the hand when sampling blood in neonates. Methods: This was a controlled randomized and double‐blinded study. One hundred and twenty neonates were randomly allocated to two groups, EMLA or placebo. Five hundred milligrams (0.5 ml) of EMLA or placebo was placed on the dorsum of the hand, covered with an occlusive dressing, and left in place for 60 minutes. For venepuncture, a needle measuring 0.9±40 mm was used. The two groups were also compared as regards the total time needed to complete the PKU test and the number of skin punctures required. The facial reaction was videotaped and later analysed by two blinded observers using the Neonatal Facial Coding System (NFCS). Results: No side effects occurred, except for a temporary blanching or redness of the skin, which disappeared within minutes. Nociceptive response: After skin puncture, the NFCS scores were significantly lower in the EMLA group than in the placebo group (median 287 and 374, respectively). After the first skin puncture, a cry was recorded in 35/55 cases (64%) in the EMLA group and in 38/56 cases (68%) in the placebo group, this difference was not significant. The duration of the first cry was significantly shorter in the EMLA than in the placebo group (median 12 and 31s, respectively). Conclusion: In comparison with a placebo, EMLA significantly reduces the pain caused by venepuncture on the dorsum of the hand and does not complicate puncture of the vein.
Diurnal rhythm of serum osteocalcin in normal children
Authors: Heuck C , Skjærbæk C , Wolthers OD
Published: August 2010

The aim of the present study was to assess diurnal levels of serum osteocalcin in normal children using a recently introduced fluoroimmunoassay (Pharmacia Osteocalcin CAP FEIA) measuring solely the intact peptide. Five girls and two boys aged 10.4–13.6 (mean 12.2) y were studied. Blood samples for determination of osteocalcin were collected every 2h throughout the day. A statistically significant rise in serum osteocalcin (F = 6:7, p < 0:001) with a peak at 08.00 h and a nadir lasting from 10.00 to 24.00 h was found. Trough and peak levels (at 16.00 and 08.00 h, respectively) were 41.6 ± 6.8 and 66.0 ± 10.5 /μg l‐1 (mean ± SEM). The circadian variation should be taken into consideration when single assessments of serum osteocalcin in children are performed.
Parents’fear regarding fever and febrile seizures
Authors: Stuijvenberg M van , Vos S de , Tjiang GCH , Steyerberg EW , Derksen‐Lubsen G , Moll HA
Published: August 2010

van Stuijvenberg M, de Vos S, Tjiang GCH, Steyerberg EW, Derksen‐Lubsen G, Moll HA. Parents'fear regarding fever and febrile seizures. Acta Pædiatr 1999; 88: 618‐22. Stockholm. ISSN 0803‐5253

In order to improve the effectiveness of information, we studied parents'perceptions and knowledge about fever and febrile seizures. A questionnaire study was carried out among the parents whose children (n = 230) participated in a randomized controlled trial of ibuprofen to prevent recurrent febrile seizures. Of the 230 parents, 181 (79%) responded to the questionnaire. Of all parents, 45% were afraid or very afraid of fever, which was strongly associated with being afraid of recurrent febrile seizures. Parents of children with a non‐West European background were more afraid. The consequences of parental fear included frequent temperature measurements (25% measured five times per day or more), sleeping in the same room (24%) and 13% remained awake at night. Witnessing a febrile seizure is a frightening experience for parents; a majority thought that febrile seizures were harmful, because they look dangerous. Forty‐seven percent thought that their child was dying during the initial febrile seizure. On the other hand, reassuring information may be helpful: 21% mentioned it as their reason to consider febrile seizures not harmful. We conclude that parental fear of fever and febrile seizures is a major problem with several negative consequences for daily family life. Adequate provision of information may reduce parental fear. We suggest that information about fever and febrile seizures should be provided to all parents, preferably during their contact with the providers of preventive healthcare. The parents of children with a non‐West European origin need extra attention. □Fever, febrile seizures, information, questionnaire
Incidence, ultrasonic patterns and resolution of nephrocalcinosis in very low birthweight infants
Authors: Saarela T , Vaarala A , Lanning P , Koivisto M
Published: August 2010

Saarela T, Vaarala A, Lanning P, Koivisto M. Incidence, ultrasonic patterns and resolution of nephrocalcinosis in very low birthweight infants. Acta Pædiatr 1999; 88: 655‐60. Stockholm. ISSN 0803‐5253

This longitudinal study was undertaken in order to elucidate the incidence and natural course of nephrocalcinosis in preterm infants and to evaluate whether the ultrasonic classification for nephrocalcinosis used here is suitable for predicting subsequent resolution of the condition. A total of 129 very low birthweight infants were screened for nephrocalcinosis by renal ultrasonography at 2 wk, 6 wk and 3 mo. The pyramidal changes were classified as peripheral, scattered or extensive. Follow‐up renal ultrasonography was performed on the infants with nephrocalcinosis at 6, 12, 18 and 24 mo, and thereafter annually up to 6 y of age, or until ultrasonic resolution. The overall incidence of nephrocalcinosis was 20% (26/129). Nephrocalcinotic changes were peripheral in 14 out of the 26 infants (54%), scattered in 7 (27%) and extensive in 5 (19%). Ultrasonic resolution had taken place in all the cases with peripheral nephrocalcinosis by 12 mo, but 3 of the 7 infants with the scattered pattern and 3 of the 4 with the extensive pattern (1 died) were still affected at 24 mo. In two cases with extensive nephrocalcinosis the condition still persisted at 5‐6 y of age. We conclude that about 20% of very low birthweight infants develop nephrocalcinosis during the first 3 mo of life. In about half of the affected infants renal changes are restricted and transient, but more extensive forms may last several years. The classification of nephrocalcinosis used here is appropriate for predicting later ultrasonic resolution. □Kidney, nephrocalcinosis, preterm infant, ultrasound
Infections in early childhood and risk of atopic disease
Authors: Pekkanen J , Remes S , Kajosaari M , Husman T , Soininen L
Published: August 2010

Having more siblings has been shown to be associated with lower risk of atopic diseases. This might be due to the higher number of infections in larger families. Because children attending day care centres have more respiratory infections, we analysed the association of number of siblings and day care attendance in children aged 1‐3 y with atopic disease in a cross sectional survey of 8387 schoolchildren aged 13‐14 y and their parents in four regions of Finland. Having no siblings, compared to three or more siblings, was associated with significantly higher risk of lifetime history of hay fever (odds ratios (OR) 1.53, 95% confidence interval (CI) 1.25‐1.86) and atopic eczema (OR 1.28, 95%CI 1.04‐1.56), and higher risk (ns) of doctor‐diagnosed asthma ever (OR 1.26, 95%CI 0.85‐1.88). Less strong associations were observed with the number of older siblings (birth order). No associations were observed with current symptoms of these diseases during the last 12 mo. Attending a day care centre at the age of 1‐3 y was not associated with decreased risk of any of the atopic diseases studied, but, in contrast to the hypothesis, was associated with slightly increased risk of current symptoms of hay fever (OR 1.34, 95%CI 1.12‐1.60). The present results suggest that other factors than early childhood respiratory infections explain the association between number of siblings and future risk of atopic disease. □Atopic disease, early life, infections
Moderate renal failure in association with prolonged acquired hypothyroidism in children
Authors: Al‐Fifi S , Girardin C , Sharma A , Rodd C
Published: August 2010

We evaluated five children with prolonged primary hypothyroidism and noted a significant reduction in renal function (40%), which was reversible with hormonal replacement. This decline was higher than reported in adults and was of sufficient magnitude to warrant altering drug‐dosing schedules. Furthermore, patients with moderately reduced renal function should be carefully evaluated for signs and symptoms of hypothyroidism. □Glomerular filtration rate, primary hypothyroidism, renal insufficiency
Acinetobacter junii causes life‐threatening sepsis in preterm infants
Authors: de Beaufort AJ , Bernards AT , Dijkshoorn L , van Boven CPA
Published: August 2010

Acinetobacter junii caused sepsis in six preterm infants in our neonatal unit within 48 h. Each infant with clinical signs of systemic infection and activation of the acute phase response had two positive blood cultures with Acinetobacter junii. The sudden onset, the short duration of the outbreak and the fact that none of the infants were colonized by A. junii suggested a common source of A. junii administered directly into the blood. The only feature shared by all six affected newborns was an intravenous fat emulsion (Intralipid 10%), which was shown to be an excellent growth medium for A. junii. Sepsis did not occur in four infants with 20% fat emulsion or amino acids only. Vaminolact® did not support growth of the outbreak strain. The immediate source of the outbreak could not be identified: samples of the actual feeds given were not available for investigation, but A. junii was not isolated from parenteral solutions with identical batch numbers used in the septic infants. We conclude that Acinetobacter junii can cause a life‐threatening infection in preterm neonates. Contaminated intravenous fat emulsion is implicated as a possible source of the infection. As a part of rigid infection control, intravenous feedings should be prepared under aseptic conditions. □Acinetobacter junii, intravenous fat emulsion, neonatal intensive care unit, outbreak, preterm infants, sepsis
Synthetic growth reference charts
Authors: Hermanussen M , Burmeister J
Published: August 2010

Distance standards of height (growth charts) tend to get out of date and must be actualized from time to time. The aim of the present meta‐analysis was to investigate characteristics of the cross sectional incremental pattern of body stature, evaluating the possibility of generating distance standards of height without the need for extensive de novo measurements. In view of the differences in growth in early and late childhood, we divided the total period of child development into the period between birth and the age of 6y, and between 6 and early adulthood (15 y in females, 18 y in males). With respect to birth length, we meta‐analysed 50 European and US American growth studies; with respect to growth in early childhood, 14 studies were analysed; and with respect to growth in late childhood, we meta‐analysed 40 male and 51 female growth studies, from 14 European countries and the USA. Variations in body stature were meta‐analysed in very large data samples, including the 1992 German birth cohort with more than 500 000 measurements of newborns, 10 000 measurements of 2‐y‐old German children, more than 500 000 measurements of German school children, and 6 large growth surveys of Japan and Czechoslovakia, with altogether more than 24 000 000 measurements. We found a rigid pattern of cross sectional body stature increment between birth and early adulthood that could be expressed by age‐specific linear regression coefficients. Body stature was found to be related between sexes. Male birth length correlated with female length (r= 0.933, p < 0.001, slope = 4.62, intercept = 0.89), stature of 6‐y‐old boys correlated with stature of 6‐y‐old girls (r= 0.96, p < 0.001, slope =1.05, intercept =‐6.75), and stature of 18‐y‐old boys correlated with stature of 15‐y‐old girls (r= 0.96, p < 0.001, slope = 0.90, intercept = 2.85). The developmental pace was also strongly related in both sexes. In conclusion, age‐specific linear regression coefficients can be utilized synthetically to generate distance standards for height (synthetic growth reference charts). Synthetic growth reference charts can help to actualize current growth charts without much additional effort, and they may also be used for populations for which autochthonous growth standards are not available. □Body stature, growth, growth study, human growth, synthetic growth reference chart
Role of postnatal penicillin prophylaxis in prevention of neonatal group B streptococcus infection
Authors: Patel DM , Rhodes PG , LeBlanc MH , Graves GR , Glick C , Morrison J
Published: August 2010

This prospective study was designed to identify the role of postnatal penicillin prophylaxis in the prevention of neonatal group B streptococcus (GBS) infection. We studied 10 998 infants. Of these, 5389 were in the penicillin prophylaxis group (PP) and 5609 infants did not receive penicillin prophylaxis (NPP). Infants were allocated to treatment by month of birth, alternating 3‐mo blocks or 2‐mo blocks to the two groups after the first block was randomly assigned. The use of PP reduced the incidence of clinical sepsis (1.7% PP versus 2.5% NPP, p<0.01), GBS infection (0.4% PP versus 0.9% NPP, p < 0.001) and deaths from sepsis (0.1% PP versus 0.3% NPP, p < 0.05). We conclude that the routine use of postnatal penicillin prophylaxis appears to be effective in reducing the incidence of clinical sepsis and death from sepsis in neonates. □Antimicrobial prophylaxis, group B streptococcus, neonatal sepsis
Concurrent administration of rhesus rotavirus tetravalent (RRV‐TV) vaccine with pentavalent diphtheria‐pertussis‐tetanus–Haemophilus influenzae b‐inactivated polio and hepatitis B vaccines
Authors: Vesikari T , Joensuu J , Baer M , Käyhty H , Ölander R‐M , Sormunen H , Miettinen A , Ward RL , Guillot T
Published: August 2010

To investigate the incorporation of oral rhesus‐human reassortant rotavirus tetravalent (RRV‐TV) vaccine into a routine immunization programme, RRV‐TV or oral placebo was coadministered with a pentavalent diphtheria‐tetanus‐whole‐cell pertussis‐Haemophilus influenzae b (Hib)‐inactivated polio vaccine and hepatitis B vaccine following a 3‐4‐5‐mo schedule in a double‐blind trial involving 249 infants. Seroconversion rates after 3 doses of rotavirus vaccine were 80% for rotavirus immunoglobulin A (IgA) and 93% for RRV neutralizing antibodies. Rotavirus vaccine did not interfere with the immune responses to diphtheria, tetanus, pertussis, Hib, poliovirus 1, 2 and 3, or hepatitis B. Following the first, second and third doses of vaccine, fever >38˚C on the day of vaccination was seen in 31%, 24% and 24%, respectively, with no difference between RRV‐TV‐ and placebo‐vaccinated children. This fever was presumably due to the whole‐cell pertussis vaccine. Those vaccinees who received concomitant RRV‐TV vaccine had another peak of fever around d 4 after the first dose, when 25% of them had fever >38˚C and 3% >39˚C. It is concluded that RRV‐TV rotavirus vaccine can be given concurrently with other childhood immunizations following a 3‐4‐5‐mo vaccination schedule. However, febrile reactions to RRV‐TV rotavirus vaccine are common when the first dose is given at the age of 3 mo. □Combined vaccinations, fever, pertussis vaccine, rhesus rotavirus, rotavirus vaccine
Interactions of infectious symptoms and modifiable risk factors in sudden infant death syndrome. The Nordic Epidemiological SIDS study
Authors: Helweg‐Larsen K , Lundemose JB , Ôyen N , Skjærven R , Alm B , Wennergren G , Markestad T , Irgens LM
Published: August 2010

The aim of the study was to investigate the effect of infection on sudden infant death syndrome (SIDS) and to analyse whether modifiable risk factors of SIDS, prone sleeping, covered head and smoking act as effect modifiers. In a consecutive multicentre case‐control study of SIDS in Denmark, Norway and Sweden, questionnaires on potential risk factors for SIDS were completed by parents of SIDS victims, and for at least two controls matched for gender, age and place of birth. All SIDS cases were verified by an autopsy. The study comprised 244 SIDS cases and 869 controls, analysed by conditional logistic regression. Significantly more cases than controls presenting symptoms of infectious diseases during the last week and/or last day were treated with antibiotics and had been seen by a physician. The finding is consistent with the hypothesis of an infectious mechanism in SIDS induced by local microorganism growth and toxin or cytokine production, and also adds further support to a possible association between infection and SIDS by loss of protective mechanisms, such as arousal. The risk of SIDS among infants with the combined presence of infectious symptoms and either of the other modfiable risk factors, prone sleeping, head covered or parental smoking, was far greater than the sum of each individual factor. These risk factors thus modify the dangerousness of infection in infancy. □Cytokines, epidemiology, infectious symptoms, Nordic study, risk factors, SIDS, toxin