bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening for neonatal hyperbilirubinaemia and ABO alloimmunization at the time of testing for phenylketonuria and congenital hypothyreosis
Authors: Meberg A , Johansen KB
Published: August 2010

In a population‐based study including 2463 infants, serum bilirubin measurements were added to the neonatal screening programme for phenylketonuria and congenital hypothyreosis. This screening programme detected 11/17 (65%) of infants with serum bilirubin levels > 350/μmol l−1, of whom 7 (3 per 1000) were readmitted from home (6 treated with phototherapy). A total of 139 infants (5.6%) received phototherapy. Maternal blood type O occurred significantly more often in term infants treated (30/54; 55.6%) compared with preterm infants treated (32/85; 37.6%) and with blood type O occurrence in the total population of mothers (906/2426; 37.3%) (p< 0:05). The blood type constellations mother O/infant A or B showed a sensitivity of 64%, specificity 65%, positive predictive value 12% and a negative predictive value of 96% for the requirement of phototherapy for the whole material. Exchange transfusion was not required in any of the infants. No infant developed bilirubin encephalopathy (kernicterus). Adding bilirubin to a neonatal screening programme detects some cases with unexpectedly high bilirubin levels in need of intervention. Routine ABO blood typing of pregnant women, ABO cord blood typing and Coombs' test in infants of mothers with blood type O cannot be recommended because of low positive predictive value for the requirement of intervention (phototherapy) by these tests.
Nutrient absorption from a fat‐enriched diet in young malnourished children: a randomized controlled trial
Authors: Arora NK , Anand NK , Bhan MK , Jailkhani B , Aggarwal A , Meenu R , Batla R
Published: August 2010

A randomized, controlled trial was undertaken to compare nutrient absorption from low fat (22.2% energy as fat) and high fat (48% energy as fat) ‐containing mixed diets in 39 (26M, 13F) malnourished children aged < 2 y. Subjects of both dietary groups, standard (SDG, n= 18) and experimental (EDG, n= 21), were offered 184.5 ml of feeds/kg body weight/24 h that provided 146 kcal with the low fat diet and 216 kcal with the high fat diet, respectively. The baseline clinical and biochemical parameters and the volume of feeds consumed by the patients in the two groups were comparable. Thus, the subjects in the EDG were ingesting a mean (95% CI) of 50% (23.8%, 76.2%) extra energy than that eaten by the SDG. Coefficients of absorption of energy, nitrogen and carbohydrate were similar in the two dietary groups (p= 0.08–0.98). Median (binomial exact 95% CI) fat absorption among subjects receiving the high fat diet (96.3; 92.9,98.6) was 7% more than in those consuming the low fat diet (89.3; 86.7, 94.1) (p= 0.01). Subjects of the EDG thus, retained almost 50% additional energy as compared to that by SDG.
Distress and the micturating cystourethrogram: does preparation help?
Authors: Phillips DA , Watson AR , MacKinlay D
Published: August 2010

This study evaluates the impact of therapeutic preparation methods on children undergoing MCUG. Parents of 35 children who had undergone MCUG were surveyed by questionnaire. The child's reaction to investigation was assessed using the Groningen Distress Rating Scale (rating 1 = calm > 5 = panic) and parental coping styles using the Utrecht Coping List. Families received one of two types of therapeutic preparation: storybooklet or storybooklet and play preparation. Reported distress levels were significantly lower with therapeutic preparation (mean score 2.5 ± 1.02 SD) than without (mean score 3.3 ± 1.22 SD). Previously, controls reported 46% of anxiety‐linked behaviour changes post‐MCUG, falling to 13% after therapeutic preparation. Parents who gave a candid explanation reported significantly lower child distress levels (mean 2.0 ± 0.91 SD) than those parents who avoided upsetting details (mean 3.1 ± 0.47 SD). We conclude that distress associated with the MCUG can be reduced by therapeutic preparation of the child and family prior to investigation.
Anxiety and depression in mothers related to severe malformation of the heart of the child and foetus
Authors: Rona RJ , Smeeton NC , Beech R , Barnett A , Sharland G
Published: August 2010

The aim of the study was to assess levels of anxiety and depression in three groups: pregnant mothers referred to foetal cardiology, subdivided into those with a confirmed diagnosis and those for which no abnormality was detected, and mothers who had a child with a heart malformation. Psychological status was measured between 6 and 10 months after diagnosis using the Hospital Anxiety and Depression scale in 108 females. Levels of anxiety were higher in the two groups with a confirmed diagnosis in the antenatal period or after birth (62%) than in those who were screened positively but in whom no abnormality was found (30%) (p= 0:0055). Anxiety was the highest in young females who had a foetus with a heart malformation. Depression scores were higher in those who had a child with heart malformation (18%) than in the other two groups (5%). Mothers who terminated a pregnancy after diagnosis remained depressed long after the event. Younger mothers may be especially vulnerable to mood problems associated with a traumatic obstetric experience.
Platelet proteins as autoantibody targets in idiopathic thrombocytopenic purpura
Authors: Wadenvik H , Stockelberg D , Hou M
Published: August 2010

Idiopathic thrombocytopenic purpura (ITP), caused by autoantibodies directed against certain platelet antigens, is the most common entity of the immune thrombocytopenias. ITP is an acquired disorder and can affect both children and adults. However, the clinical syndromes of ITP are distinct between children and adults. Childhood (acute) ITP characteristically is acute in onset, occurs within 1‐2 weeks of an infection, usually of viral origin, resolves spontaneously within 6 months. Adult (chronic) ITP has an insidious onset and rarely resolves spontaneously. Over the last decade considerable new information has accumulated as to the pathophysiological mechanisms of immune thrombocytopenias. In addition, most of the knowledge on this disorder has been obtained from studies of adult patients with chronic ITP. The present work gives an updated overview of the platelet autoantigens and the molecular immunological reactions in ITP.
Lower level of serum potassium and higher level of C‐reactive protein as an independent risk factor for giant aneurysms in Kawasaki disease*
Authors: Koyanagi H , Nakamura Y , Yanagawa H
Published: August 2010

Giant aneurysms are the most serious issue of patients with Kawasaki disease (KD). To clarify risk factors for these giant aneurysms, we conducted a matched case‐control study. Among the patients reported in nationwide surveys, 117 patients with giant aneurysms had an unequivocal new diagnosis and presented at the treatment center within 9 d of illness. We obtained clinical information on admission of about 69 patients (case) from the treatment centers. One control was selected for each case, an age‐ and sex‐matched patient without coronary involvement, reported from the same treatment center at about the same time as the case, and we obtained the same clinical information about controls. Fourteen variables were analysed with a conditional logistic regression model: body temperature, hematocrit, hemoglobin, numbers of leukocyte and platelets, concentrations of serum albumin, globulin, total cholesterol, sodium, potassium and chloride, erythrocyte sedimentation rate, C‐reactive protein and alanine aminotransferase activity. After adjustment for age, duration of illness before admission and use of intravenous gamma globulin therapy, C‐reactive protein [odds ratio (OR)= 1.142, 95% confidence interval (CI) 1.054‐1.237], alanine aminotransferase activity (OR= 1.008, 95% CI 1.002‐1.014), serum sodium concentration (OR = 0.877, 95% CI 0.770‐0.999) and serum potassium concentration (OR = 0.319, 95% CI 0.124‐0.822) were significantly related to the risk for giant aneurysms. Further analyses with these four explanatory variables revealed that C‐reactive protein (OR = 1.159,95% CI 1.022‐1.315) and serum potassium concentration (OR = 0.222,95% CI 0.052–0.948) met the significant level. Thus, the values for serum C‐reactive protein and potassium are independent risk factors for the development of the giant aneurysms of Kawasaki disease.
Birth stress increases adrenomedullin in the newborn
Authors: Boldt T , Luukkainen P , Fyhrquist F , Pohjavuori M , Andersson S
Published: August 2010

Adrenomedullin is a peptide that induces pulmonary vasodilation in experimental animals. Adrenomedullin was measured in blood samples from cord artery and vein from 41 term newborns. In 23 of the newborns delivered vaginally, levels of adrenomedullin in the cord artery, 71.8 ± 45.8 pg ml‐1 (mean ± SD), and vein, 75.6 ± 45.2 pg ml‐1, were significantly higher than in 18 newborns delivered by elective Caesarean section (40.7 ± 14.6pgml‐1 and 32.4 ±10.3 pgml‐1, respectively; both p < 0:01). A significant correlation existed between the concentration of adrenomedullin and pH in the cord artery (r= ‐ 0:545, p = 0:002). The fetus responds to birth stress by secreting high concentrations of adrenomedullin. As a potent vasodilator, the peptide may play a role in postnatal cardiovascular adaptation.
Pharmacokinetics, dose adjustments, and 6‐mercaptopurine/ methotrexate drug interactions in two patients with thiopurine methyltransferase deficiency
Authors: Andersen J Brandt , Szumlanski C , Weinshilboum RM , Schmiegelow K
Published: August 2010

Two children with acute lymphoblastic leukaemia (ALL) were found to be thiopurine methyltransferase (TPMT)‐deficient by both genotype and phenotype. They were monitored with haematological parameters and red blood cell concentrations of 6‐thioguanine nucleotides (E‐6TGN) and methotrexate (E‐MTX, including MTX polyglutamates), in relation to the doses of 6‐mercaptopurine (6MP) and methotrexate (MTX), during their maintenance chemotherapy. Both patients developed severe pancytopenia at the standard protocol dose of 6MP. Even at 25% and 5%, respectively, of the protocol dose of 6MP, they achieved E‐6TGN values several‐fold above the population median, but without unacceptable bone‐marrow toxicity. Their high E‐6TGN values had only a minor influence on their E‐MTX values and their tolerance to oral MTX, but severe pancytopenia followed high‐dose MTX infusions. Due to the risk of fatal myelo‐suppression we recommend up‐front determination of TPMT activity in patients treated with 6MP or azathioprine.
Ureaplasma urealyticum, erythromycin and respiratory morbidity in high‐risk preterm neonates
Authors: Jonsson B , Rylander M , Faxelius G
Published: August 2010

We investigated colonization with Ureaplasma urealyticum (Uu) in infants <30 weeks gestation and assessed the relationship to other risk factors influencing respiratory morbidity, plus the effect of treatment with erythromycin. Ventilated preterm infants [n= 155; median GA 26 (23–29) weeks] were cultured for Uu in endotracheal aspirate and nasopharynx. Colonized infants were randomly assigned to treatment with erythromycin 40mg/kg/d, intravenously or orally. The rate of colonization was 29/155 (19%) and the Uu‐colonized infants had lower mean gestational ages than the culture‐negative infants (25 vs 26 weeks). For the colonized infants PROM (48% vs12%), chorioamnionitis in the mother (46% vs 17%) and vaginal delivery (71% vs 29%) were more common. More colonized infants needed supplemental oxygen at 36 weeks’postconceptual age (p< 0:05). Erythromycin treatment was effective in reducing colonization with negative control cultures in 12/14 (86%) of treated infants. No significant differences were found between the colonized treated infants (n= 14) and those not treated (n= 14) in time with supplemental oxygen. Oxygen requirement at 36 weeks was related to lower gestational age, late appearance of PDA, late onset sepsis and signs of chorioamnionitis in the mother. We conclude that the Uu colonization is related to increasing immaturity, the presence of prolonged rupture of membranes, signs of chorioamnionitis and vaginal delivery. Treatment with erythromycin reduced colonization but did not significantly alter length of time with supplemental oxygen.
Bone marrow fibrosis and radiological changes of the long bones in children with acute megakaryocytic leukaemia
Authors: Abrahamsson J , Swolin B , Mellander L
Published: August 2010

The diagnosis of acute megakaryocytic leukaemia (AMkL) may be difficult to establish owing to difficulties in obtaining adequate bone marrow aspirates secondary to bone marrow fibrosis. We describe three children without Down's syndrome under 2 y of age with AMkL. Although none of the patients had the non‐random t (1;22) (p13;q13) translocation, bone marrow cells from all patients exhibited chromosome abnormalities with complex karyotypes, including trisomy 21 in two cases. All patients had profound bone marrow fibrosis and characteristic lamellar diaphyseal radiological changes of the long bones.
Quality of general movements in preterm infants with transient periventricular echodensities
Authors: Bos AF , Martijn A , Okken A , Prechtl HFR
Published: August 2010

By means of sequential videotape recordings, the relevance of the quality of general movements for neurological outcome was determined in a group of 21 appropriate‐for‐gestational‐age preterm infants with transient periventricular echodensities of variable localization and duration and in 6 infants without echodensities. Echodensities, especially in the parieto‐occipital area, affected the quality of general movements. Echodensities persisting beyond 14 d were associated with abnormal general movements; infants with echodensities up to 14 d had either normal or abnormal general movements. The developmental course of movement quality was correlated to neurological outcome (p < 0:005): normal outcomes were found in 11/12 infants with normal general movements throughout and in 9/11 infants with transient abnormal general movements; all 4 infants with persistent abnormal general movements had impaired outcomes. In infants with transient echodensities, longitudinal assessment of the quality of general movements helps to determine if there is brain dysfunction, either transient or persistent, and identifies infants at risk for impaired neurological outcomes.
Preoperative bacterial colonization of the upper airways does not predict postoperative airway infection in children
Authors: Gardlund B , Rimeika D , Wedelin B , Laska J
Published: August 2010

The aim of this prospective non‐interventional investigation was to study whether preoperative colonization of nasopharynx with potentially pathogenic airway bacteria carried an increased risk for the development of early postoperative bacterial airway infections after heart surgery in preschool children. Of the 91 patients studied, 62 (68%) were colonized preoperatively in the nasopharynx with Moraxella catarrhalis, Streptococcus pneumoniae, Haemophilus influenzae and/or Staphylococcus aureus. Nine children developed postoperative airway infections (four pneumonia, three bacterial bronchitis and two acute otitis media). Preoperative colonization was not significantly associated with increased risk for postoperative airway infection: 6/62 (10%) in colonized vs 3/29 (10%) in non‐colonized children. Preoperative nasopharynx cultures in asymptomatic children should be avoided since it is unpleasant for the child, is not cost‐effective, and may lead to unnecessary antibiotic treatment.
Recommendations for the implementation of Kangaroo Mother Care for low birthweight infants
Authors: Cattaneo A , Davanzo R , Uxa F , Tamburlini G ,   The International Network on Kangaroo Mother Care
Published: August 2010

Good quality care of low birthweight infants could reduce neonatal mortality in low‐income countries, but the technologies used in rich countries are inappropriate. Kangaroo Mother Care does not need expensive and sophisticated equipment, and for its simplicity it can be applied almost everywhere, including peripheral maternity units of very low‐income countries. Kangaroo Mother Care (KMC) can also contribute to the humanization of neonatal care and to better bonding between mother and baby in both poor and rich countries. A group of health professionals with experience in KMC met in a workshop to discuss its effectiveness, safety, applicability and acceptability in different settings: from first and second level maternity units in settings with very limited resources, to second and third level units in settings with limited resources, to second and third level maternity and neonatal care units in settings with ample resources and infant mortality rates <15/1000. The paper summarizes the recommendations of this group of health professionals for the implementation of KMC in these various settings, together with suggested research priorities.
Combination of ABO blood group incompatibility and glucose‐6‐phosphate dehydrogenase deficiency: effect on hemolysis and neonatal hyperbilirubinemia
Authors: Kaplan M , Vreman HJ , Hammerman C , Leiter C , Rudensky B , MacDonald MG , Stevenson DK
Published: August 2010

The incidence (%) of hyperbilirubinemia (serum bilirubin ≥257 μmol/l) was similar in neonates with a combination of ABO incompatibility and glucose‐6‐phosphate dehydrogenase (G‐6‐PD) deficiency (45%), with ABO incompatibility (54%) or G‐6‐PD deficiency (37%), alone (ns). Carboxyhemoglobin values, corrected for inspired CO, were similarly elevated in all three groups (0.87 ± 0.32%, 0.82 ± 0.29%, 0.76 ± 0.18%, respectively, ns), but correlated with bilirubin only in those with ABO incompatibility alone. ABO‐incompatible/G‐6‐PD‐deficient neonates, compared with those with either condition alone, are not at increased risk for hemolysis or hyperbilirubinemia.
Relationship of apolipoprotein E phenotypes to serum lipid and lipoprotein levels in Japanese schoolchildren
Authors: Okada T , Sato Y , Iwata F , Hara M , Kim H , Harada K
Published: August 2010

The distribution of apolipoprotein (apo) E phenotypes was investigated in Japanese schoolchildren and an attempt was made to determine whether the apoE phenotypes influence the serum levels of lipid and lipoprotein. The subjects were 289 children from ajunior high school (145 M, 144 F, aged 12–13 y). TheE3/3 phenotype was demonstrated in 69.9%, E4/3 in 18.7%, E2/3 in 9.0%, E4/2 in 1.4%, E4/4 in 0.7% and E5/4 in 0.3%. E2/2 was not detected. Serum levels of total cholesterol and low‐density lipoprotein‐cholesterol were progressively lower in the phenotypes E4/3, E3/3 and E2/3. The serum level of high‐density lipoprotein‐cholesterol showed a progressive increase in the same order. In conclusion, Japanese schoolchildren with E4/3 already had an atherogenic serum lipid profile.
Adult height comparison between boys and girls with precocious puberty after long‐term gonadotrophin‐releasing hormone analogue therapy
Authors: Galluzzi F , Salti R , Bindi G , Pasquini E , La Cauza C
Published: August 2010

We examined 22 girls and 11 boys with idiopathic precocious puberty (IPP) treated with a GnRH analogue for a period of about 4 y. The purpose of our study was to evaluate possible differences between the two sexes in bone growth and skeletal maturation during treatment and in the achievement of final height, and also to study the relative contribution of particular hormones–sex steroids, DHEAS, GH and IGF‐I–during the pubertal growth spurt. At the beginning of therapy mean chronological age (CA) was 7.61 ± 0.84 y in boys and 7.32 ± 1.06 y in girls. After the first year of treatment, growth velocity and Dbone age/Dchronological age (ΔBA/ΔCA) ratio had declined significantly in both groups. At the end of therapy we observed a statistically relevant increase in predicted adult height in both sexes, with a more appreciable mean gain (expressed as SDS) being achieved by male patients. During the first year following discontinuation of treatment, a significant increase in the ΔBA/ΔCA ratio was observed in both males and females; by contrast, growth velocity increased only in male patients. Adult height SDS was thus greater in boys (0.13 ± 0.91) than in girls (‐0.62 ± 0.88,p < 0:05). With regard to endocrinological data, oestradiol and testosterone were significantly reduced during the first year of therapy, while DHEAS levels increased slightly in both sexes throughout the course of treatment. GH peak after clonidine and IGF‐I concentrations remained unchanged in both groups. Also, a study of nocturnal GH secretion (10 subjects) showed no noteworthy decrease in any of the patients, whether in terms of mean GH, of the sum of pulse amplitudes, or of pulse frequency. In conclusion, our data indicate that boys achieve more significant results in terms of adult height than girls. With reference to endocrinological data, the effect of sex steroids on bone maturation seems to be more significant than previously thought, and we hypothesize a different role for androgens and oestrogens in regulating height velocity and bone maturation in both male and female subjects during pubertal growth spurt.
Disease of the liver following bone marrow transplantation in children: incidence, clinical course and outcome in a long‐term perspective
Authors: Frisk P , Lönnerholm G , öberg G
Published: August 2010

Sixty‐four consecutive cases of allogeneic (n= 16), autologous (n= 47) or syngeneic (n= 1) bone marrow transplantation (BMT) in children with haematological or lymphoid malignancy, aplasia or metabolic disease were reviewed to assess the incidence, clinical presentation and outcome of liver disease. Median follow‐up time was 5 y (1.0‐10). No liver diagnosis was established at the pre‐transplant check‐up. During the first 100d post‐transplant, 81% of the patients had impaired liver function as documented by various biochemical parameters. Three of 64 patients (5%) met diagnostic criteria for veno‐occlusive disease. Four (25%) of the 16 receiving allografts were diagnosed as having acute graft vs host disease (GVHD) with liver involvement (grades II‐III). No patient died of liver disease. During the late post‐transplant follow‐up, one patient developed HCV hepatitis after packed erythrocyte transfusion. Four patients were diagnosed as having chronic GVHD with liver involvement; three of them also had an episode of CMV hepatitis. At their latest follow‐up, the patients with chronic GVHD had aminotransferase values 1.5–3 times the normal, whereas all other long‐term survivors had normal or near‐normal liver function tests. We conclude that the incidence of serious liver disease was low in this paediatric population of bone marrow recipients.
Zinc deficiency in rapidly growing preterm infants
Authors: Obladen M , Loui A , Kampmann W , Renz H
Published: August 2010

Symptomatic zinc deficiency was observed in a 24‐week gestation, 640 g birthweight infant fed exclusively with maternal breast milk. Our hypothesis was that subclinical Zn deficiency is not uncommon in very low birthweight infants because fortified human milk and preterm formula may contain little Zn. Zinc serum concentrations determined in 26 consecutive very low birthweight infants (gestational age 23‐32, median 27 weeks), prior to discharge, at a chronological age of 37‐121 (median 72) d, were found between 1.0 and 14.0 (median 6.4) μmol/l, in 14 infants they were below the normal range of 7.6–15.0 μmol/l. Serum alkaline phosphatase and iron intake did not correlate with Zn concentrations. Nutritional supply of Zn and other trace elements by breast milk fortifiers and infant formulas currently used in Germany does not appear to meet the demands of rapidly growing extremely low birthweight infants during the first months of life.
Specific cellular immunity in immunocompetent children with herpes zoster
Authors: Terada K , Tanaka H , Kawano S , Kataoka N
Published: August 2010

We investigated whether specific immunity is low in immunocompetent children with zoster. Specific cellular immunity was found to be significantly lower in 13 otherwise normal children with zoster than it was in 8 matched controls by a lymphoproliferative assay. However, there was no significant difference between them with regard to the antibody response. Therefore, even in the immunocompetent children, decreased specific cellular immunity may play an important role in the mechanism of virus reactivation.
The prevalence and related symptomatology of Helicobacter pylori in children with recurrent abdominal pain
Authors: Wewer V , Andersen LP , Pærregaard A , Gernow AB , Hansen JP Hart , Matzen P , Krasilnikoff PA
Published: August 2010

The aim of the study was to assess and compare the IgG seroprevalence of H. pylori in children with recurrent abdominal pain with healthy children and to investigate the related symptoms. IgG antibodies against low‐molecular weight H. pylori antigens were assessed in 438 children with recurrent abdominal pain and in 91 healthy controls. Sera with an ELISA unit‐value above the cut‐off level were confirmed by Western immunoblot. Only seropositive children with recurrent abdominal pain were examined by an oesophago‐gastro‐duodenoscopy. Symptomatology was recorded according to the localization of the abdominal pain, presence of pyrosis, nocturnal pain, relation of pain to meals and bowel irregularities. The seroprevalence was 21% (95% CI: 17‐25%) in the children with recurrent abdominal pain and 10% (95% CI: 5–18%) in the healthy controls (p= 0:30). In seropositive children with RAP H. pylori was found in 46/66 by culture and histology. The presence of H. pylori was significantly associated with active or inactive chronic gastritis. The presence of H. pylori was associated with both parents being born in a country with a high prevalence and a low social class. Helicobacter pylori‐positive children had more often pain related to meals than the H. pylori‐ negative children. No differences among the two groups were seen according to the levels of haemoglobin, leucocytes, thrombocytes, weight and height. In conclusion, the seroprevalence of H. pylori is comparable in children with recurrent abdominal pain and healthy children. No specific symptomatology was seen in H. pylori‐ positive children with RAP.
Experiences of special gynaecological services for children and adolescents: a descriptive study
Authors: Piippo SH , Lenko HL , Laippala PJ
Published: August 2010

Gynaecological examination of girls during childhood is undertaken somewhat infrequently. These genital examinations should not be taboo or a frightening experience for the girl, for her parents or for the physician. Studies of children suspected of sexual abuse have paid attention to the wide variety of gynaecological conditions already present in childhood. In 1988 we founded a special gynaecological outpatient clinic for girls under 16 y of age at a university hospital to develop the special knowledge and skills needed in children's gynaecology. In this gynaecological clinic for children and adolescents we were able to gain and offer expert knowledge of the problems of this age group. In this special clinic for children, gynaecological examination by special techniques and sonography led to a diagnosis in 71% of the patients without any instrumentation. Children and adolescent girls in need of special gynaecological care should be recognized specifically. Particular attention should be paid to the gynaecological care of victims of child sexual abuse and mentally or physically handicapped girls. In good co‐operation with the girl, a gynaecological examination can become a positive experience during the development of female identity.
Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings
Authors: Cattaneo A , Davanzo R , Worku B , Surjono A , Echeverria M , Bedri A , Haksari E , Osorno L , Gudetta B , Setyowireni D , Quintero S , Tamburlini G
Published: August 2010

A randomized controlled trial was carried out for 1 y in three tertiary and teaching hospitals, in Addis Ababa (Ethiopia), Yogyakarta (Indonesia) and Merida (Mexico), to study the effectiveness, feasibility, acceptability and cost of kangaroo mother care (KMC) when compared to conventional methods of care (CMC). About 29% of 649 low birthweight infants (LBWI; 1000‐1999 g) died before eligibility. Of the survivors, 38% were excluded for various reasons, 149 were randomly assigned to KMC (almost exclusive skin‐to‐skin care after stabilization), and 136 to CMC (warm room or incubator care). There were three deaths in each group and no difference in the incidence of severe disease. Hypothermia was significantly less common in KMC infants in Merida (13.5 vs 31.5 episodes/100 infants/d) and overall (10.8 vs 14.6). Exclusive breastfeeding at discharge was more common in KMC infants in Merida (80% vs 16%) and overall (88% vs 70%). KMC infants had a higher mean daily weight gain (21.3 g vs 17.7 g) and were discharged earlier (13.4 vs 16.3 d after enrolment). KMC was considered feasible and presented advantages over CMC in terms of maintenance of equipment. Mothers expressed a clear preference for KMC and health workers found it safe and convenient. KMC was cheaper than CMC in terms of salaries (US$ 11 788 vs US$ 29 888) and other running costs (US$ 7501 vs US$ 9876). This study confirms that hospital KMC for stabilized LBWI 1000‐1999 g is at least as effective and safe as CMC, and shows that it is feasible in different settings, acceptable to mothers of different cultures, and less expensive. Where exclusive breastfeeding is uncommon among LBWI, KMC may bring about an increase in its prevalence and duration, with consequent benefits for health and growth. For hospitals in low‐income countries KMC may represent an appropriate use of scarce resources.
Rhabdomyolysis in European viper bite
Authors: Denis D , Lamireau T , Llanas B , Bedry R , Fayon M
Published: August 2010

The case of a child who presented with severe rhabdomyolysis associated with renal failure after a viper bite is reported. Rhabdomyolysis is a serious complication resulting from systemic envenomation and is uncommon after viper bites in Europe. It may be due to oedema, myotoxic agents and haemorrhagic factors and may be responsible for two types of potentially fatal complications, i.e. acute renal failure and hyperkalaemia. The present case highlights the need to investigate routinely for rhabdomyolysis after viper bites. Antivenom therapy is recommended as soon as signs of envenomation are present, without waiting for the onset of complications.
Role of parvovirus B19 infection in childhood idiopathic thrombocytopenic purpura
Authors: Heegaard ED , Rosthøj S , Petersen BL , Nielsen S , Pedersen F Karup , Hornsleth A
Published: August 2010

Heegaard ED, Rosthøj S, Petersen BL, Nielsen S, Karup Pedersen F, Hornsleth A. Role of parvovirus B19 infection in childhood idiopathic thrombocytopenic purpura. Acta Pædiatr 1999; 88: 614‐7. Stockholm. ISSN 0803‐5253

Although parvovirus B19 exhibits a strong tissue‐tropism for erythroid progenitor cells leading to anaemia, several case reports indicate that parvovirus B19 infection may also cause the development of thrombocytopenia. Despite recent studies, the frequency and clinical relevance of this association have remained questionable. Consequently, and in view of the paucity of evidence regarding a viral aetiology for idiopathic thrombocytopenic purpura (ITP), we examined the role of parvovirus B19 in 47 children with newly diagnosed ITP. Specific viral DNA indicating a current or recent parvovirus B19 infection was demonstrated in 6 of 47 patients (13%) employing the polymerase chain reaction technique. Our study suggests that children with ITP and associated parvovirus B19 infection are characterized by acute onset of profound thrombocytopenia. Among the parvovirus B19 positive children, duration of disease was brief in three children treated with immunoglobulin but chronic in the remaining three patients given high‐dose steroids. Prospective studies are needed to confirm these initial observations. This virus should be considered as a possible aetiologic agent in some children with ITP. □Idiopathic thrombocytopenic purpura, immunoglobulin, parvovirus B19, polymerase chain reaction
COMMITTEE REPORT
Authors: Läckgren G , Hjalmås K , Gool J van , Gontard A von , Gennaro M de , Lottmann H , Terho P
Published: August 2010

Läckgren G, Hjälmås K, van Gool J, von Gontard A, de Gennaro M, Lottmann H, Terho P. Nocturnal enuresis: a suggestion for a European treatment strategy. Acta Pædiatr 1999; 88: 679‐90. Stockholm. ISSN 0803‐5253

The objective of this study was to review the published literature on aetiology and treatment of nocturnal enuresis, with the aim of providing a treatment strategy which is easy for the patient and their family to follow. Results from European studies conducted over the last 15 y were included in this review. It can be concluded from the results of these studies that enuresis is the cause and not the result of a psychiatric disorder. However, there is still considerable variation in success rates, from 28 to 90%. It is of vital importance that a caring approach from the doctor and a positive family and patient attitude are present for successful treatment. The first choice of treatment should be the one most acceptable to the family, e.g. alarm, desmopressin and combination treatment. □Alarm, desmopressin, nocturnal enuresis, polyuria, vasopressin
Efficacy of nebulized budesonide compared to oral prednisolone in acute bronchial asthma
Authors: Devidayal  , Singhi S , Kumar L , Jayshree M
Published: August 2010

To evaluate the efficacy of nebulized budesonide compared to oral prednisolone early in the emergency room management of acute asthma, we conducted a double‐blind, placebo‐controlled trial. Eighty children, 2 years to 12 years of age, with acute moderate attacks of asthma, were randomized into two groups. One group received nebulized salbutamol (0.15mg/kg) and placebo at half‐hourly intervals for three doses, and a single dose of oral prednisolone (2 mg/kg) (prednisolone group) and other group received three doses of nebulized salbutamol and budesonide (800 μg) at half‐hourly intervals and a single dose of placebo tablets (budesonide group). The baseline characteristics of the two groups were similar, but after three doses of nebulization oxygen saturation, respiratory rate, pulmonary index and respiratory distress score were significantly improved in the budesonide group compared to prednisolone group (p < 0.01). The proportion of patients who were fit for discharge at the end of 2 h after the third dose of nebulization was significantly higher in the budesonide group than in the prednisolone group (22/ 41, 54% vs 7/39, 18%, p < 0.001). The data suggest that a combination of nebulized salbutamol and budesonide should be preferred in the emergency room management of children with acute moderate to severe exacerbation of asthma and who are not on prior oral or inhaled steroid therapy. □Asthma, budesonide, emergency care, glucocorticoids
A case associated with Walker Warburg syndrome phenotype and homozygous pericentric inversion 9: coincidental finding or aetiological factor?
Authors: Baltaci V , Örs R , Kaya M , Balci S
Published: August 2010

We describe a rare occurrence of pericentric inversion in homologues of chromosome 9 observed in a 2‐mo‐old female baby with eye and brain abnormalities. Her clinical and neuroradiological features are similar to the signs of Walker‐Warburg syndrome. We found the same inversion in heterozygous condition in all metaphases of both parents, who are related, and in two grandparents and their mother. The cytogenetic abnormality alone does not explain the phenotype in this patient, but it warrants further linkage studies with emphasis on the pericentric region of chromosome 9 in patients with Walker‐Warburg syndrome phenotype. This family case is unique and raises suspicions about whether the pericentric region of chromosome 9 has any connection with the phenotype of Walker‐Warker syndrome. □Chromosome 9 pericentric inversion, consanguinity, homozygosity, Walker‐Warburg syndrome
Assessment of stool colour in community management of prolonged jaundice in infancy
Authors: Crofts DJ , Michel VJ‐M , Rigby AS , Tanner MS , Hall DMB , Bonham JR
Published: August 2010

Jaundice persisting beyond the first 2 wk of life is often regarded as an indication for investigation to exclude cholestatic liver disease. Most babies with prolonged jaundice have breast milk‐related jaundice, which is a benign condition. Cholestatic liver disease is usually accompanied by pale stools and yellow or orange urine. A community programme was established to ascertain the incidence of prolonged jaundice and determine whether abnormal stool and urine colour could be used to assist primary care staff in referral decisions. Data were collected on normal stool and urine colour and used to devise a colour chart and information sheet for parents. Babies with prolonged jaundice were identified and referred for investigation. In all, 3661 babies were recruited into the study, of which 127 were jaundiced at 28 d of age. Of these, 125 were breastfed. The incidence of jaundice in breastfed babies at 28 d was 9.2% (95% CI 7.8%‐11.0%) Abnormal liver function tests (LFTs) were common, but no baby had abnormal stool or urine colour and none was found to have liver disease. Jaundiced breastfed babies who are well are unlikely to have serious disease. Elevated LFTs are compatible with a diagnosis of breast milk‐related jaundice. Prolonged jaundice in bottle‐fed babies, and persistent pallor of stools or yellow/orange urine, are rare and merit immediate referral. Parents and professionals can be advised to report pale stools without generating a large number of unnecessary referrals. Further work is needed to determine whether a colour chart reduces the mean age of referral and treatment of infants with cholestatic liver disease. □Breast milk jaundice, hyperbilirubinaemia, jaundice, liver function tests, stool colour
Early discharge of preterm infants needing limited special care, followed by domiciliary nursing care
Authors: Örtenstrand A , Waldenström U , Winbladh B
Published: August 2010

The aim of this study was to evaluate the effect of early discharge, followed by domiciliary nursing care, on infant health and utilization of health services in preterm infants still in need of special care (mainly gavage feeding). In total, 88 infants who were physiologically stable, but in need of further special care such as gavage feeding, were allocated to an early discharge group (EDG = 45 infants) and offered home visits by a nurse backed up by a neonatologist, or to a control group offered standard neonatal care (CG = 43 infants). Infants in the EDG spent 30.6 d (mean) in hospital after birth compared with 46.3 d in the CG (p= 0.003). On average, the domiciliary nurse spent 10.4 h with each family in the EDG, including a median number of 5 home visits, scheduled telephone contact and travelling time. The infants had a mean of 1.7 scheduled visits and 0.4 unscheduled visits to the neonatal ward. The domiciliary nurse received a mean of 0.9 telephone calls from the parents. When the period of domiciliary care in the EDG (post‐conceptional age 35.9—38.7 wk) was compared with the corresponding time in hospital in the CG (post‐conceptional age 35.6—38.6 wk), no statistical differences were observed in infant health, surgical procedures or medication. However, a reduced incidence of respiratory infections was observed in the EDG (6 versus 16 infants; p= 0.02). Nine infants in the EDG were re‐hospitalized. The two groups did not differ in the numbers of rehospitalizations and non‐elective contacts with the health services during the first year after discharge. In conclusion, early discharge of preterm infants still requiring special care, followed by domiciliary nursing care, was associated neither with an increased utilization of health services after discharge, nor with infant morbidity after discharge. More information on safety is needed before widespread early discharge can be advocated. □Domiciliary care, early discharge, gavage feeding, nursing, preterm infants
Glycine and other neurotransmitter amino acids in cerebrospinal fluid in perinatal asphyxia and neonatal hypoxic‐ischaemic encephalopathy
Authors: Roldán A , Figueras‐Aloy J , Deulofeu R , Jiménez R
Published: August 2010

The aim of this study was to evaluate the concentrations of neurotransmitter amino acids in the cerebrospinal fluid (CSF) of asphyctic newborns, and to establish whether these concentrations are related to the degree of hypoxic‐ischaemic encephalopathy (HIE). Levels of glutamate, aspartate, glycine and taurine in CSF were measured in 48 full‐term newborns during the first 2 d of life. Thirty‐nine of these newborns had birth asphyxia and were divided into three groups: 11 without HIE, 19 with mild HIE and 9 with moderate HIE. None suffered from severe HIE. They were compared with a control group of 9 non‐hypoxic newborns. Determinations of the amino acids in CSF were made by chromatography and expressed as μmol/1 (mean ± SD). CSF glycine value was related to erythrocyte count, and CSF taurine value was related to its plasmatic level. Levels of CSF glycine were related to the severity of HIE (p= 0.020): control (12.08 ± 4.04 μmol/1), without HIE (12.49 ± 4.04 μmol/1), mild HIE (12.14 ± 3.83 μmol/1), and moderate HIE (19.1 ± 10.08 μmol/1; p<0.05 versus mild HIE), even after removing the influence of red cells in CSF.
Nitric oxide inhalation inhibits pulmonary apoptosis but not inflammatory injury in porcine meconium aspiration
Authors: Holopainen R , Aho H , Laine J , Halkola L , Kääpa P
Published: August 2010

To investigate the possible protective effects of nitric oxide (NO) inhalation in newborns with meconium aspiration, 18 10‐12‐d‐old piglets were studied for 6h after an intratracheal bolus (3 ml/kg) of a 65‐mg/ml mixture of human meconium. Twelve of the piglets were treated with continuous NO inhalation at a dose of 1 ppm (n = 6) or 10 ppm (n = 6), started 30 min before the insult. Pulmonary haemodynamics and systemic oxygenation were followed, and lung tissue samples were studied for signs of inflammation, evidence of ultrastructural injury and apoptotic cell changes. Inhalation of 10 ppm NO, in contrast to 1 ppm NO, significantly delayed the meconium‐induced pulmonary pressure rise and the increase in intrapulmonary shunt fraction, and maintained better oxygenation in the piglets. Histologically and biochemically, treatment with 1 or 10 ppm NO inhalation did not protect the lungs against meconium‐induced inflammatory injury. Further, ultrastructural lung tissue analysis revealed a significant amount of alveolar exudate and oedematous alveolar epithelium and endothelium after meconium instillation, also in the lungs treated with NO inhalation. However, the increase in apoptotic epithelial cell deaths, previously shown to be stimulated by intratracheal meconium, was significantly impeded after inhalation of 10 ppm. These results thus show that early continuous NO inhalation controls the rise in pulmonary artery pressure and improves the efficiency of arterial oxygenation, and further prevents the increase in epithelial apoptosis, but does not protect against early inflammatory damage caused by meconium aspiration.
Combination of von Willebrand disease type 1 and partial factor XII deficiency in children: clinical evidence for a diminished bleeding tendency
Authors: Zeitler P , Meissner N , Kreth HW
Published: August 2010

Factor XII deficiency can be associated with a thrombotic and VWF deficiency with a haemorrhagic clinical course. To study the potential influence of factor XII deficiency on bleeding tendency in patients suffering from VWD we retrospectively compared the clinical outcome of children with either an isolated factor XII deficiency, an isolated VWD, or a combination of both. Patients with the combined coagulation defect showed significantly fewer bleeding events when compared to patients with isolated VWD, although ristocetin cofactor activities were reduced to a comparable degree. As far as aPTT values are concerned, there were no significant differences among the three groups. Whether this combination of thrombophilic and haemorrhagic coagulation disorders is only coincidental or the result of an active modulation of one of the two counteracting coagulation factors is not known at present.
Use of a pacifier and behavioural features in 2–4‐month‐old infants
Authors: Kelmanson IA
Published: August 2010

This study aimed to analyse a possible association between the use of a pacifier and particular behavioural features in 2‐4‐month‐old infants as estimated by the means of the Early Infancy Temperament Questionnaire (EITQ). It comprised 192 randomly selected clinically healthy infants born in St Petersburg in 1997‐1998. The mothers were asked to complete the questionnaires addressing infant, maternal and major demographic characteristics, and childcare practices, with particular emphasis on the use of a pacifier, as well as to fill in the EITQ. The EITQ scores nine different aspects of infant temperament: activity, rhythmicity, approach, adaptability, intensity, mood, persistence, distractibility and threshold. A total of 117 of 192 infants (60.9%) used pacifiers, and they appeared to have more rhythmic behaviour than non‐users. This effect remained after adjustment was made for major potential confounding and/or modifying factors, including gender, parity, details from perinatal history and familial social background, feeding pattern, bed sharing and room sharing. With the exception of rhythmicity, no significant association was found between the use of a pacifier and any other particular feature of infant temperament. Use of a pacifier may be associated with higher rhythmicity in 2–4‐month‐old infants.
Free secretory component as a standardization protein for nasopharyngeal specimens from children with upper respiratory tract infection
Authors: Heikkinen T , Shenoy M , Goldblum RM , Chonmaitree T
Published: August 2010

Free secretory component (FSC) has been recommended as a reliable protein for correction of the unknown dilution in tracheal aspirate samples from preterm infants. To investigate whether FSC would also provide a valid standardization protein for samples of nasopharyngeal secretions, this study determined the intersubject variation and the alteration over time in the concentrations of FSC in nasal secretions from 35 children (median age 14 months) who participated in an antibiotic efficacy trial. Nasopharyngeal aspirates were obtained at enrolment and after 2–3 d. FSC in the specimens was quantified by a direct enzyme immunoassay. The concentrations of FSC in the nasal secretions ranged from 0.08 to 189.6 μgml−1 (median 12.3 μgml−1); the ratio of the highest to the lowest concentrations was 2370, the difference between the 90th and 10th percentile concentrations was 189‐fold and the difference between the 75th and 25th percentile values was 26. FSC concentrations were significantly lower in children aged <12 months (median 2.2 μg ml−1) than in the older children (median 21.5 μg ml−1; p= 0.035). Between the first and the follow‐up specimens, 65% of the children had >2‐fold difference in the levels of FSC in the secretions. Because an optimal standardization protein should show minimal variation between individuals and over time, FSC may not be a suitable protein for correction of the unknown dilution of nasopharyngeal specimens from children with upper respiratory tract infection.