bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive value of umbilical cord blood bilirubin for postnatal hyperbilirubinaemia
Authors: Knüpfer Matthias , Pulzer Ferdinand , Gebauer Corinna , Robel‐Tillig Eva , Vogtmann Christoph
Published: August 2010

Aim: The study investigated the predictive value of umbilical cord serum (UCS) bilirubin for the postnatal course of bilirubinaemia in healthy term and near‐term newborns. Methods: Term appropriate‐for‐gestational‐age (AGA; n=1100), small‐for‐gestational‐age (SGA; n=163) and near‐term infants (GA 34–36 wk; n=78) were included and separated according to their UCS bilirubin levels, starting from <20 (group 1), 20–<30 (2), 30–40 (3) and >40 (4) μmol/l. The newborns were followed for at least 5 postnatal days, and UCS bilirubin values were correlated with the development of hyperbilirubinaemia and phototherapy (PT) treatment. Results: A clear relation between UCS bilirubin and the development of hyperbilirubinaemia was found in all three patient populations. None of the 75 AGA patients of group 1 developed postnatal bilirubin values above 300 μmol/l, whereas 0.3, 3.4 and 8.6% of the patients in groups 2–4, respectively, did so. The frequency of PT increased from 0% in group 1 up to 9.6% in group 4. For the prediction of further need of PT using a UCS bilirubin cut‐off level of 30 μmol/l, we found a sensitivity of 90% and a negative predictive value of 99.1%, indicating that all patients with UCS bilirubin values below 30 μmol/l (443/1100 or 40.2%) were at a very low risk of developing dangerous hyperbilirubinaemia. Similar results were obtained in SGA children with a sensitivity of 94.1% and a negative predictive value of 98.6%. In comparison to term newborns, we generally found higher bilirubin values in preterms. A total of 6.4% of preterm children developed bilirubin values over 300 μmol/l, compared with 3% of term children, and 47.4% of preterms had to be treated with PT. Predicting the need of PT by using a UCS bilirubin cut‐off level of 30 μmol/l revealed a sensitivity of 70.3% and a negative predictive value of 65.6%.

Conclusion: These data suggest that UCS bilirubin is useful in predicting the postnatal bilirubin values in term and near‐term newborns. We presume that the use of UCS bilirubin values may help detect infants at low risk for postnatal hyperbilirubinaemia and minimize an unnecessary prolongation of hospitalization.
Socio‐demographic determinants of initiation and duration of breastfeeding in northwest Russia
Authors: Grjibovski Andrej M , Yngve Agneta , Olov Bygren Lars , Sjöström Michael
Published: August 2010

Aim: This study examines socio‐demographic determinants of initiation and duration of breastfeeding in a community‐based cohort in northwest Russia. Methods: All infants born to women who were registered at the antenatal clinics in Severodvinsk in 1999 comprised the cohort (n=1399) and were followed up at 1 y. Data on maternal and infant characteristics as well as the duration of breastfeeding were obtained from medical records. Proportional hazard analysis was applied to quantify the effect of the selected factors on the risk of breastfeeding discontinuation adjusted for potential confounders. Results: Only 1.3% of infants were never breastfed. Breastfeeding rates were 75.0% and 47.2% at 3 and 6 mo, respectively. Maternal age and early initiation of prenatal care were positively associated with breastfeeding initiation rates. Increased risks of breastfeeding discontinuation were found in teenage mothers (OR=1.45, 95% CI: 1.06–1.99), in mothers with basic education (OR=1.68, 95% CI: 1.06–2.66) and in unmarried mothers (OR=1.19, 95% CI: 1.03–1.38). Women with no previous deliveries were more likely to breastfeed longer (OR=0.74, 95% CI: 0.62–0.90).

Conclusions: Compared with previous studies in Russia, almost universal initiation and considerably higher rates of breastfeeding at specific time points were found. Social variations in initiation and duration of breastfeeding should raise concern of inequalities in breastfeeding practices in transitional Russia.
Group discussions with parents have long‐term positive effects on the management of asthma with good cost‐benefit
Authors: Hederos Carl‐Axel , Janson S , Hedlin G
Published: August 2010

Aim: To investigate if an intervention with extra information and support in a group setting to parents of preschool children could improve adherence and clinical outcome. Methods: This is a controlled, prospective study where the parents of 60 newly diagnosed preschool asthmatic children aged 3 mo–6 y were randomized to either a control group or to an intervention that consisted of four group sessions in close connection with the diagnosis. The basic education on asthma and the written treatment plan were the same in both groups. The outcome measures were questionnaires to the parents and classification of the children according to symptoms and medication. The adherence rate and the burden of asthma were calculated with the help of diaries and weighing of the MDIs used between 12 and 18 mo after inclusion. Results: The follow‐up rate was 85% after 18 mo. The parents’ presence in the sessions was around 70%, with no gender difference. The parents’ view on adherence issues improved significantly in the intervention group. In the control group, 30% had poor adherence compared to 8% in the intervention group (p=0.015). Both the parents and the paediatricians underestimated the number of children with poor adherence. The children in the intervention group had significantly fewer exacerbation days during the last 6 mo—2.1 compared to 3.9 d/child—although they had lower inhaled steroid doses after 18 mo. An economic calculation showed that the intervention was profitable.

Conclusion: This intervention resulted in an improvement in the parents’ view on adherence, in the measured adherence rates and in the clinical outcome.
A comparison of high and standard blood transfusion volumes in premature infants
Authors: Wong Hubert , Connelly Robert , Day Andrew , Flavin Michael P
Published: August 2010

We compared high volume (20 ml/kg) with standard volume (15 ml/kg) packed red blood cell (PRBC) transfusions in a randomized trial. Ten high volume babies received a mean of 2.8 transfusions, while 10 standard volume babies received a mean of 3.4 (p=0.58). No adverse events were attributed to the use of the high volume transfusions.

Conclusion: Higher transfusion volumes appear to be well tolerated. The data can be used in the planning of larger controlled trials in VLBW infants.
Cardiac tamponade and pericardial effusion due to venous umbilical catheterization
Authors: Traen Marijke , Schepens Elisabeth , Laroche Sabine , van Overmeire Bart
Published: August 2010

Aim: We present three cases of neonatal cardiac tamponade due to umbilical venous catheterization, a rare, but potentially fatal complication. Methods: Timely diagnosis was made by echocardiography, and an urgent pericardiocentesis revealed TPN fluid. Perforation of the cardial wall was proven by contrast X‐ray showing contrast diffusing into the pericardial space. Discussion: Most frequently, perforation has a delayed course and results from endothelial injury, caused by the hyperosmolar fluids, leading to transmural necrosis and thrombosis. Subsequently, the fluid diffuses transmurally across the myocardium into the pericardium. As migration of the catheter tip can occur, we suggest that its position should be checked immediately after insertion and twice a week thereafter.

Conclusion: Pericardial effusion and cardiac tamponade should be considered in any infant with a central venous line who develops a rapid, unexplained clinical deterioration. Timely diagnosis and drainage has been proven to be life‐saving.
Modifiable risk factors for SIDS in Germany: Results of GeSID
Authors: Vennemann Mechtild M T , Findeisen Martina , Butterfaß‐Bahloul Trude , Jorch Gerhard , Brinkmann Bernd , Köpcke Wolfgang , Bajanowski T , Mitchell Ed A
Published: August 2010

Background: The incidence of sudden infant death syndrome (SIDS) has been falling in Germany over the last decade. However, little is known about the prevalence and the importance of well‐known risk factors in Germany since a local prevention campaign in 1992. Design: A 3‐y, population‐based, case‐control study was conducted in half of Germany, consisting of 333 cases. All sudden and unexpected deaths in infancy, if they fitted the inclusion criteria, were included in the study. Parental interview was carried out soon after the death, and three living control infants, matched for age, gender, region and sleep time, were recruited. Results: The prevalence of placing infants prone to sleep was only 4% in the control group, but this was associated with a markedly increased risk of SIDS (adjusted odds ration, aOR=6.08). Other modifiable risk factors for SIDS were: maternal smoking during pregnancy, breastfeeding for less than 2 wk (aOR=1.71) and co‐sleeping (aOR=2.71), while using a pacifier during the last sleep reduced the risk (aOR=0.39).

Conclusions: Previously recognized risk factors for SIDS also occur in Germany. Despite knowledge about the major modifiable risk factors for SIDS, these factors are still present in Germany. To reduce the incidence of SIDS in Germany, a continued effort is needed to inform all parents about preventable risk factors for SIDS.
Comparison of clinical characteristics between astrovirus and rotavirus infections diagnosed in 1997 to 2002 in Hungary
Authors: Jakab Ferenc , Péterfai János , Meleg Edina , Bányai Krisztián , Mitchell Douglas K , Szűcs György
Published: August 2010

Aim: To determine the severity and clinical characteristics of human astrovirus (HAstV) infections among hospitalized children and compare them with children infected by rotavirus. Methods: Retrospective, case‐control study of astrovirus‐infected and rotavirus‐infected children. Astroviruses were detected in stool samples by enzyme immunoassay and/or reverse transcriptase‐polymerase chain reaction. All stool samples were tested for rotavirus and bacterial pathogens, and all negative samples were further tested for human astrovirus. Children with astrovirus‐positive stool samples and complete clinical data were included in this study. Results: Astrovirus was detected in 29 (1.8%) children, and 63 rotavirus‐infected children were included as controls. Astrovirus‐infected children had shorter duration of diarrhea than rotavirus‐infected children (median 4 and 6 d, respectively; p<0.05), and 79% of the astrovirus infections were associated with a short duration of vomiting (median 1 and 4 d, respectively; p<0.0001). Rotavirus‐infected children had longer hospitalization (p<0.050) than astrovirus‐infected children.

Conclusion: HAstV‐infected children had similar symptoms to those occurring in rotavirus infection. However, astrovirus‐infected patients had a significantly shorter duration of diarrhea and vomiting, and they required a shorter hospitalization. On the basis of the clinical data and severity scores, children with rotavirus infection had more severe illness.
The prevalence of coeliac disease as detected by screening in children with iron deficiency anaemia
Authors: Kalayci Ayhan Gazi , Kanber Yilmaz , Birinci Asuman , Yildiz Levent , Albayrak Davut
Published: August 2010

Aim:Iron deficiency anaemia is a frequent finding seen in coeliac disease, which can be diagnosed alone or with other findings. In this study, our aim was to determine the prevalence of coeliac disease in children with iron deficiency anaemia without significant gastrointestinal symptoms.Methods:There were 135 children with iron deficiency anaemia in the patient group (group 1), and 223 healthy children without iron deficiency anaemia in the control group (group 2) in this study. Antiendomysial antibody (EMA) IgA test was given to both groups. Antiendomysial antibody‐positive patients underwent small intestine biopsy.Results:The mean age was 7.2±4.6 (2–16) y in the patient group (group 1) and 8.2±3.8 (2–16) y in the control group (group 2), and no significant difference between the two groups was detected. In terms of gender, there was a significant difference between groups 1 and 2 (M/F: 74/61 and 98/125, respectively) ( p<0.05). EMA was positive in six cases in group 1 (4.4%), and villous atrophy and/or inflammation in the lamina propria with increased intraepithelial lymphocytes was seen on small intestine biopsy in these patients. In the control group, EMA was negative in all children. In detailed histories of patients with coeliac disease diagnosis, recurrent iron deficiency anaemia/pica was found in four patients (66.7%) and occasionally foul‐smelling or watery stool attacks were seen in four patients (66.7%). Three of these six patients (50%) had short stature.

Conclusion:The prevalence of coeliac disease was high in patients with iron deficiency anaemia; therefore, gastrointestinal findings should be further examined for coeliac disease, and the possibility of coeliac disease should be investigated in patients with recurrent iron deficiency anaemia and short stature.
Maternal consumption of dairy products during pregnancy and lactation, and the development of cow's milk antibodies in the offspring
Authors: Erkkola Maijaliisa , Kronberg‐Kippilä Carina , Savilahti Erkki , Kenward Michael G , Salonen Marja , Ilonen Jorma , Knip Mikael , Äkerblom Hans K , Virtanen Suvi M
Published: August 2010

Objective: To assess whether the maternal consumption of milk and milk products affects development of cow's milk (CM) antibodies in infants. Design: A randomized pilot trial using food frequency questionnaires (mothers) and food records (infants). Setting: Families with a newborn infant with increased HLA‐DQB1‐conferred risk of type 1 diabetes and at least one first‐degree relative affected by type 1 diabetes from 16 hospitals in Finland between April 1995 and November 1997. Subjects and intervention: Infants randomized to receive a hydrolysed formula when breast milk was not available during their first 6–8 mo (n=112). Of these, 13 dropped out by the age of 3 mo and two were excluded due to incomplete CM antibody data. Results: Maternal milk protein intake from cheese during pregnancy was inversely related to IgA‐class antibody titres to beta‐lactoglobulin (BLG) and casein (CAS) at 3 mo, and to IgA antibody titres to BLG at 6 mo. Maternal consumption of raw milk products during lactation was positively related to the development of IgA antibody titres to CAS at 6 mo, and inversely correlated to IgG antibody titres to bovine serum albumin (BSA) and IgA antibody titres to CAS at 2 y. Maternal cheese consumption was inversely related to the IgG antibody titres to CM formula and CAS and to the IgA antibody titres to CAS in early infancy.

Conclusions: Few associations were established between maternal CM protein intake and CM protein antibody levels in the infants. The milk and milk products taken by the mother differed in their impact on the emerging CM antibody response in the offspring.
Cognitive and educational outcomes in early adulthood for infants weighing 1000 grams or less at birth
Authors: Lefebvre Francine , Mazurier Évelyne , Tessier Réjean
Published: August 2010

Aim: To assess the intelligence quotient (IQ) and academic achievement in early adulthood of a cohort of extremely‐low‐birthweight (ELBW 1000 g) subjects. Methods: All 82 ELBW survivors consecutively born in or referred to a single tertiary center in 1976–1981 were traced at a mean age of 18 y. Three disabled children had died. Fifty‐nine subjects (75%) had their IQ tested and 69 (87%) responded to a questionnaire. They were compared to 44 term, normal birthweight (NBW) matched controls. Outcome measures were: IQ (Wechsler Adult Intelligence Scale) and educational outcome. The main outcome variables were compared between groups and analyzed for neonatal and demographic data and in the ELBW group for childhood data. Results: There was a strong relationship (r2=0.55, p<0.0001) between childhood and adult IQ for the 41 ELBW subjects tested at both ages (6.1±1.3 and 18.4±1.9 y). Differences were significant between ELBW and NBW groups: in mean full‐scale IQ (94±12 vs 108±14), verbal IQ (93±12 vs 106±14) and performance IQ (97±14 vs 109±16) (p<0.0001). Differences between ELBW and NBW groups in prevalence of IQ<85 (19 vs 2%, p=0.012), of schooling in a regular curriculum for age (36 vs 68%, p=0.0011), of requirement for special classes or schools (33 vs 9%, p=0.0032), and of obtainment of secondary school diploma for those 18 y or older (56 vs 85%, p=0.018) were largely due to fathers’ socio‐economic score.

Conclusion: ELBW subjects had a mean adult IQ in the normal range; however, it was one standard deviation below that of NBW subjects and they had more school failures. Despite this, more than half of ELBW subjects aged 18 y or more had obtained their secondary school diploma.
Aplasia cutis congenita of the scalp: How much therapy is necessary in large defects?
Authors: Bernbeck B , Schwabe J , Groninger A , Schaper J , Messing‐Jünger H , Mayatepek E , Rosenbaum T
Published: August 2010

Aim: To show that local antibiotic management and a regular inspection of aplasia cutis congenita of the skull can give an excellent result. Method: This case reports a girl born with aplasia cutis congenita of the skull presenting with a large aplasia of the epidermis, dermis, subcutaneous tissue and galea, including a bone defect without any additional risk factor, e.g. early eschar formation, cerebrospinal fluid leakage or uncommon dural blood vessels. Results: A primarily conservative treatment with local wet and antibiotic dressings together with a systemic antibiotic treatment for the first 2 wk led to an excellent result and thus prevented untimely operative and peri‐operative procedures.

Conclusions: Here we have shown that conservative treatment might be an option, even if the wound diameter is greater than 1 cm2, to prevent infants from any untimely operative procedure with an elevated operative risk if any additional risk factors are excluded.
Primary cutaneous aspergillosis (PCA)—a case report
Authors: Andresen Jannicke , André Nygaard Egil , Størdal Ketil
Published: August 2010

Primary cutaneous aspergillosis is a rare diagnosis. Predisposing factors are immunodeficiency and macerated skin. The mortality of infections with Aspergillus species is high, especially in neonatal intensive care units (NICUs). We present a premature (24 wk of gestation) infant with primary cutaneous aspergillosis appearing on the sixth day of life. Predisposing factors in this patient were prematurity, extremely vulnerable skin, treatment with antibiotics and renovation in the radiology department nearby. The patient was treated with amphotericin B intravenously for a total of 40 d. He did not have, nor develop, disseminated aspergillosis, and suffered no side effects from the treatment. The only remaining trace of his infection was scarring in the affected area.

Conclusion: After having treated this patient successfully and having gone through the available literature, we conclude that treating primary cutaneous aspergillosis with intravenous amphotericin B prevents disseminated aspergillosis and is the treatment of choice.
Prevalence and aetiology of congenital birth defects, infant mortality and mental retardation in Lahore, Pakistan: A prospective cohort study
Authors: Gustavson Karl‐Henrik
Published: August 2010

Aim: To study the health and development of children in a developing and low‐income country. Methods: The health and development of children in Lahore in northern Pakistan have been studied since 1981 in a collaborative project between Pakistani and Swedish university institutions and the Swedish Agency for Research Cooperation with Developing Countries (SAREC). The study described in this paper comprised four different areas in Lahore with different degrees of urbanization and different social conditions. All pregnancies in the four areas were registered during the period March 1984 to July 1986 and were followed up from the 5th month of pregnancy. All 1476 children born after 1 September 1984 were followed up from birth to 12 y of age. Results: The perinatal mortality in the whole material was 5.4%. It was highest in the periurban slum (7.5%) and lowest in the upper‐middle class cohort (3.3%). Overall infant mortality was 10%. It was highest (14%) in the periurban slum and lowest (2%) in the upper‐middle class group. Overall incidence of serious birth defects was 5%. It was highest in the periurban slum community (7%) and lowest in the upper‐middle class cohort (3%). The overall cumulative incidence of severe mental retardation per 100 live births was 1.1. It was highest (2.2) in the periurban slum and lowest (0.4) in the upper‐middle class group. The overall prevalence of mild mental retardation among 6–10‐y‐old children was 6.2 per 100. It was highest in the periurban slum (10.5) and lowest (1.3 per 100) in the upper‐middle class group. Poverty, malnutrition, birth trauma and consanguinity were common causes of infant mortality and mental retardation in Lahore, Pakistan.

Conclusion: Preventive measures with provision of obstetric and health services, services for genetic information and risk evaluation, vaccination programmes and identification of children with retarded development for specific stimulation and habilitation measures, e.g. organized play activities, are important in developing and low‐income countries.
Starting the process of mother–infant bonding
Authors: Kennell John , McGrath Susan
Published: August 2010

Establishing a bond between a mother and her newborn is essential for the infant to grow and thrive in the mother's care. Hospital staff can promote the creation of this bond by providing continuous support during labor, by placing the newborn skin‐to‐skin on the mother's chest immediately after delivery until the infant latches on for the first feeding, by encouraging continued breastfeeding, and by keeping mother and infant always together in the first hours and days after delivery.

Conclusion: Even in cases where the mother initially rejects her infant, sensitive medical personnel can provide an environment which allows the bond between mother and infant to begin.
A randomized trial comparing beractant and poractant treatment in neonatal respiratory distress syndrome
Authors: Ann Malloy Colleen , Nicoski Pamela , Muraskas Jonathan K
Published: August 2010

Aim: To compare the effects of beractant and poractant in neonatal respiratory distress syndrome (RDS). Methods: Infants with RDS were randomized to receive beractant or poractant. The primary outcome measure was fraction of inspired oxygen (FiO2) requirement in the first 48 h after surfactant therapy. Results: 58 infants completed the study. The mean gestational ages for the poractant and beractant groups were 29.6±3.6 and 29.3±2.9 wk, with average birthweights of 1394±699 and 1408±534 g, respectively. In the first 48 h, infants who received poractant had a lower FiO2 requirement compared to those who received beractant (p=0.018). The prevalence of patent ductus arteriosus (PDA) was lower in the group of infants that received poractant (17%) compared to the group that received beractant (45%) (p=0.02).

Conclusions: Infants with RDS treated with poractant had a lower FiO2 requirement during the first 48 h compared to infants who received beractant. Infants who received poractant also had fewer PDAs than infants who received beractant. The difference in FiO2 was not associated with a difference in age of first extubation, total intubation time, or incidence of bronchopulmonary dysplasia between groups.
Long‐term circulatory and renal consequences of intrauterine growth restriction
Authors: Simeoni Umberto , Zetterström Rolf
Published: August 2010

Intrauterine growth restriction (IUGR) and probably also early postnatal altered nutrition in very‐low‐birthweight babies may, in the long term, be followed by the various disorders that are included in the metabolic syndrome. This discovery has raised a new paradigm about the background to cardiovascular disease, arterial hypertension, obesity, type 2 diabetes and dyslipidaemic disorders that play a prominent role in shortening human life. In this review article, present knowledge about the background to renal dysfunction as seen in IUGR is summarized. The way in which arterial hypertension and cardiovascular dysfunction may be programmed in IUGR is also speculated.

Conclusion:During the last decade, knowledge of the long‐term consequences of IUGR has increased at a very rapid rate. At present, it is most important not only to develop efficient methods of preventing and diagnosing IUGR, but to work out follow‐up and treatment programmes for the control of the disorders which may follow this condition. Proper postnatal feeding and infant growth may be essential for long‐term outcome.
Small‐for‐gestational‐age infants need dietary quality more than quantity for their development: The role of human milk
Authors: Agostoni Carlo
Published: August 2010

Infants born small for gestational age (SGA) show some forms of developmental delay throughout paediatric age, and up to adolescence. The positive effect of breastfeeding on development, observed in most studies on healthy, term infants, seems to be further stressed in the group of SGA infants, particularly if breastfeeding is protracted. Besides the close maternal–infant contact of breastfeeding, the nutritional factors of human milk, above all long‐chain polyunsaturated fatty acids, including docosahexaenoic acid, may at least partly account for the observed association.

Conclusion: SGA infants represent a high‐risk group, not only for developmental delay, but also for long‐term, unfavourable metabolic consequences. Breastfeeding and human milk quality together could help to prevent some of the neurological and metabolic sequelae of being born growth retarded.
Obstetric ectoscopy, also a paediatric concern
Authors: Bergström Staffan
Published: August 2010

By coining a new concept, “obstetric ectoscopy”, attention is drawn to the fact that undergraduate and postgraduate training in obstetrics and perinatal medicine in low‐income countries is not geared towards community obstetrics, rather to more prestigious and lucrative endoscopy. It is argued that the devastation of maternal mortality leaves the clinical profession inactive and indifferent and that a more ectoscopic spirit would better prepare future obstetricians in efforts to enhance maternal and perinatal survival.
Dexamethasone inhalations in RSV bronchiolitis: A double‐blind, placebo‐controlled study
Authors: Bentur Lea , Shoseyov David , Feigenbaum David , Gorichovsky Yilena , Bibi Haim
Published: August 2010

Objective: To evaluate the effect of inhaled dexamethasone on hospitalization for respiratory syncytial virus (RSV) bronchiolitis. Study design: A double‐blind, placebo‐controlled study compared nebulization of dexamethasone versus nebulization of 0.9% saline. Both groups were treated with epinephrine nebulizations. Follow‐up continued for 3 mo. Patients and methods: Sixty‐one infants with bronchiolitis aged 3 to 12 mo were included. They were randomly allocated to nebulizations with 0.25 mg dexamethasone every 6 h (group 1) or an equivalent amount of normal saline (group 2). Results: No statistically significant differences with respect to clinical score, oxygen saturation, or IV fluid requirement between the groups were noted. Using Kaplan‐Meyer's method, the cumulative proportion of in‐hospital stay was significantly lower in group 1 compared with group 2, mainly in days 5 and 6 post‐hospitalization (p<0.038). A subgroup of prematurely born children in group 1 had a shorter hospitalization period (6.5±1.7 d) compared with group 2 children (9.1±1.9) (p<0.018). Follow‐up revealed similar wheeze and hospitalization rates in the two groups.

Conclusion: Inhaled dexamethasone may reduce the length of hospitalization among infants with acute viral bronchiolitis, especially among those born prematurely.
Learning disabilities in a population‐based group of children with hydrocephalus
Authors: Lindquist Barbro , Carlsson Göran , Persson Eva‐Karin , Uvebrant Paul
Published: August 2010

Aim: To assess cognitive functions in a population‐based group of children with hydrocephalus and to analyse differences between children with and without myelomeningocoele (MMC); with hydrocephalus already present at birth and those who developed it later; children born at full term and those born preterm. Methods: Of 103 children with hydrocephalus born in the western‐Swedish region in 1989–1993, 73 were assessed using the Wechsler Intelligence Scales or the Griffith Developmental Scales. Results: One‐third of the children were normally gifted (IQ>85), another 30% had a low average IQ of 70–84 and 37% had learning disabilities with an IQ of <70. The median IQ was 75, verbal IQ 90 and performance IQ 76 (p<0.001). An IQ of <70 was found in 19 of 45 (42%) children without MMC and in 8 of 28 (29%) of those with MMC. Children born preterm had a lower IQ of 68 than those born at full term with an IQ of 76, while children with hydrocephalus present at birth but without MMC had a lower IQ of 60 than the others with an IQ of 77. Children with cerebral palsy and/or epilepsy (n=22) had a lower IQ of 66 than the IQ of 78 in those without these impairments (p<0.01).

Conclusion: Cognitive functions in children with hydrocephalus need to be carefully assessed before school age to ensure adequate support and education. Even the one‐third near normally gifted children with an IQ of 70–85 require special attention, due to the profile of relatively well‐preserved verbal functions but greatly impaired perceptual and non‐verbal abilities.
Recombinant human activated protein C, heparin and melagatran in umbilical cord versus adult plasma
Authors: Koestenberger Martin , Cvirn Gerhard , Gallistl Siegfried , Kutschera Joerg , Muntean Wolfgang
Published: August 2010

Aim: We investigated the anticoagulant effects of recombinant human activated protein C (rhAPC), unfractionated heparin (UH) and melagatran (a new direct thrombin inhibitor [DTI]), when administered individually and in combinations of rhAPC with either UH or melagatran, in umbilical cord and adult plasma. rhAPC is a promising candidate treatment to improve the outcome of severe sepsis in neonates and adults; the DTI melagatran represents a potential advance in antithrombotic therapy. Methods: The anticoagulant efficacy of these drugs was measured using the standard coagulation assays activated partial thromboplastin time (aPTT) and prothrombin time (PT). Results: Administered individually, rhAPC, UH and melagatran dose‐dependently prolonged aPTT to a significantly greater extent in umbilical cord than in adult plasma. Melagatran alone, but not rhAPC or UH alone, dose‐dependently prolonged the PT in both umbilical cord and adult plasma. Combining rhAPC with either UH or melagatran significantly augmented aPTT prolongation in both umbilical cord and adult plasma.

Conclusion: Our results, which facilitate estimation of rhAPC and melagatran dose requirements in umbilical cord plasma, may be of benefit in critically sick newborns with severe sepsis.
Response to resuscitation of the newborn: Early prognostic variables
Authors: Didrik Saugstad Ola , Ramji Siddarth , Rootwelt Terje , Vento Maximo
Published: August 2010

Aim: To characterize the development of clinically relevant variables the first minutes after birth and identify early prognostic markers in newborn infants requiring resuscitation. Methods: A database of 591 infants resuscitated with either 21% or 100% oxygen was analysed. Time to first breath, development in heart rate, Apgar scores, arterial oxygen saturation (SaO2), and base deficit (BD) are described in relation to different degrees of birth depression and outcomes. Results: Heart rate and Apgar scores increased quickly even in the most depressed infants but were significantly lower in those having a poor outcome. By contrast, BD normalized at the same rate, 6–7 mmol/l/h, in the first hour of life regardless of the degree of birth depression and outcome. SaO2 values increased as quickly in room air as in 100%‐oxygen‐resuscitated infants. Time to first breath was prolonged threefold, from 1 to 3 min, in the most depressed (1‐min Apgar score <4) compared with the less depressed infants. Highest odds ratio (OR) for death in the first week of life or for development of hypoxic‐ischaemic encephalopathy (HIE) stage 2 and 3 was a 5‐min heart rate 60 bpm (OR 16.5 for both death and HIE) and Apgar <4 (OR 14 and 18.8). Neonatal survival for HIE stage 1, 2, and 3 was 93%, 63%, and 11%, respectively. OR for early neonatal death, if SaO260% at 1 min, was 8.6 (sensitivity 0.82 and specificity 0.65).

Conclusion: Apgar scores, heart rate, SaO2, and time to first breath in newly born infants in need of resuscitation may be used for early identification of infants with a poor prognosis. These data may be helpful in describing the severity of depression in single infants and to select infants in need of interventional therapy.
Cerebral blood flow and morphological changes after hypoxic‐ischaemic injury in preterm lambs
Authors: Hilario Enrique , Carmen Rey‐Santano Mari , Goñi‐de‐Cerio Felipe , Jose Alvarez Francisco , Gastiasoro Elena , Eugenia Mielgo Victoria , Caballero Amale , Valls‐i‐Soler Adolfo , Gómez‐Urquijo Sonia , Alvarez Antonia
Published: August 2010

Aim: To evaluate the effect of cerebral hypoxia‐ischaemia induced by partial occlusion of the umbilical cord on the relationship of the regional cerebral blood flow and the cerebral cell death in near‐term fetal lambs. Methods: Fifteen near‐term lambs were assigned to two hypoxic‐ischaemic groups with or without life support (3 h), and a healthy one. Hypoxia‐ischaemia was induced by partial occlusion of the umbilical cord (60 min). Routine light and electron microscopy, and the TUNEL method for apoptosis were performed. Regional cerebral blood flow was measured by coloured microspheres. Cardiovascular, gas exchange and pH parameters were also evaluated. Results: Both hypoxic‐ischaemic groups produced a transient acidosis and a decrease of base excess in comparison to the healthy group. Cortical and cerebellar zones, where the regional cerebral blood flow values were similar to baseline, showed an increased number of oligodendrocyte‐like apoptotic cells. In contrast, in the inner zones, where regional cerebral blood flow was increased, the number of apoptotic cells did not increase. Necrotic neurons were observed in the basal nuclei, mesencephalon, pons and deep cerebellar nuclei.

Conclusion: Our results suggest that regional cerebral blood flow and the presence of apoptotic cells, 3 h after hypoxic‐ischemic injury, are correlated.
Nitric oxide in neonatal transposition of the great arteries
Authors: El‐Segaier Milad , Hellström‐Westas Lena , Wettrell Göran
Published: August 2010

Three newborn infants with transposition of the great arteries (TGA) and intact ventricular septum (IVS) developed postnatal persistent pulmonary hypertension of the newborn (PPHN) and were successfully treated with inhaled nitric oxide (iNO). Intervention with balloon atrial septostomy (BAS) was performed in two of the infants before the iNO treatment, but they continued to be severely hypoxic with metabolic acidosis. However, the iNO immediately improved oxygenation and the clinical condition. The third neonate had a moderately large atrial communication and echocardiographic signs of PPHN. He received iNO before BAS with dramatic clinical improvement, which therefore postponed BAS.

Conclusion: Early diagnosis of PPHN and treatment with iNO may improve final outcome in neonates with TGA and IVS. In the presence of moderately large atrial communication and PPHN, treatment with iNO might be considered before BAS.
Infant milk feeding practices in the Netherlands and associated factors
Authors: Lanting Caren I , van Wouwe Jacobus P , Reijneveld Sijmen A
Published: August 2010

Aim: The aim of the study was to describe infant feeding practices and associated factors, and to explore mothers' main reasons for starting and stopping breastfeeding. Methods: We performed a national inquiry into milk feeding practices among 9133 Dutch infants aged <7 mo by means of a questionnaire. Results: 78% of mothers initiated breastfeeding. At 1 and 4 mo, respectively, 51 and 25% of infants were fed primarily on human milk; after 6 mo, only 15% of mothers still provided human milk as the only source of milk feeding. During the whole 6‐mo period, another 11 to 18% was fed on both breast and formula milk. Women initiating breastfeeding were more likely to be higher educated, have a higher‐educated partner, be non‐smokers, have a full‐time job, and be primipareous. In addition, breastfeeding initiation rate was higher for women born outside the Netherlands. Longer duration of breastfeeding was mostly found amongst higher‐educated, non‐smoking women. The odds for continuation of breastfeeding after 4 mo increased when mothers' working hours did not exceed 16 h/wk. Infant delivery at home was associated with a higher initiation rate as well as longer duration of breastfeeding compared to hospital delivery. Infants born after 38 wk of gestation, with a birthweight of 3500 g had higher odds to be breastfed for a longer period.

Conclusion: Only a minority of Dutch infants is breastfed for 6 mo. Maternal and infant characteristics are important predictors of breastfeeding initiation and duration.
Substance use and suicidal conduct: A study of adolescents hospitalized for suicide attempt and ideation
Authors: Méan Marie , Camparini Righini Nadia , Narring Françoise , Jeannin André , Michaud Pierre‐André
Published: August 2010

Aim: To study the prevalence of psychoactive substance use disorder (PSUD) among suicidal adolescents, psychoactive substance intoxication at the moment of the attempt, and the association between PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s). Methods: 186 adolescents aged 16 to 21 y hospitalized for suicide attempt or overwhelming suicidal ideation were included (T0); 148 of them were traced again for evaluations after 6 mo (T1) and/or 18 mo (T2). DSM‐IV diagnoses were assessed each time using the Mini International Neuropsychiatric Interview. Results: At T0, 39.2% of the subjects were found to have a PSUD. Among them, a significantly higher proportion was intoxicated at the time of the attempt than those without PSUD (44.3% vs 25.4%). Among the 148 adolescents who could be traced at either T1 or T2, two died from suicide and 30 repeated suicide attempts once or more times. A marginally significant association was found between death by suicide/repetition of suicide attempt and alcohol abuse/dependence at baseline (OR=3.3, 95% CI 0.7–15.0; OR=2.6, 95% CI 0.7–9.3). More than one suicide attempt before admission to hospital at T0 (OR=3.2, 95% CI 1.1–10.0) and age over 19 y at T0 (OR=3.2, 95% CI 1.1–9.2) were independently associated with the likelihood of death by suicide or repetition of suicide attempt.

Conclusion: Among adolescents hospitalized for suicide attempt or overwhelming suicidal ideation, the risk of death or repetition of attempt is high and is associated with previous suicide attempts—especially among older adolescents—and also marginally associated with PSUD; these adolescents should be carefully evaluated for such risks and followed up once discharged from the hospital.
Familial haemophagocytic lymphohistiocytosis: Survival of a premature twin with immuno‐chemotherapy and bone marrow transplantation from an HLA‐identical unrelated donor
Authors: Rugolotto Simone , Luigi Marradi Pier , Balter Rita , Maccario Rita , Maria Padovani Ezio , Locatelli Franco
Published: August 2010

We describe a premature twin born at 30 wk of gestational age, affected with familial haemophagocytic lymphohistiocytosis. Two different mutations were identified in his DNA: one inherited from the mother and one from the father. Haemophagocytosis had been confirmed in his twin brother, who died soon after birth, as well as in the re‐evaluation of the autopsy of his older sister, who died 1 y earlier. At 26 d of age, chemotherapy and immune‐suppressive treatment were started according to the HLH‐94 protocol. At 6 mo of age, a bone marrow transplant from an HLA‐identical, unrelated volunteer was performed. Now at 32 mo of age, the infant is healthy and without signs of graft‐versus‐host disease.

Conclusion: This case report shows that immuno‐chemotherapy and allogenic bone marrow transplant are feasible even in premature infants affected with familial haemophagocytic lymphohistiocytosis, which should be ruled out in unknown bleeding disorders of neonates.
Death in two female Prader‐Willi syndrome patients during the early phase of growth hormone treatment
Authors: Riedl Stefan , Blümel Peter , Zwiauer Karl , Frisch Herwig
Published: August 2010

Reports on sudden death in Prader‐Willi syndrome (PWS) patients after the start of growth hormone (GH) treatment have been published recently. We observed a 4.7‐y‐old girl who showed a continuous increase in pulmonary artery pressure and died of cardiorespiratory failure 7 wk after GH therapy had been initiated, and a 9.3‐y‐old girl with additional trisomy 21 who died during a minor respiratory infection 6 mo after GH had been started. Both patients were overweight (weight for height 127% and 224%, respectively). GH‐induced fluid retention may have occurred in the younger girl. In contrast to the reported cases, our PWS patients were female.

Conclusion: Our cases illustrate the difficulty of differentiation between possible GH side effects and the natural course of disease, in particular with respect to obesity‐related comorbidity and mortality.
A six‐year old with fatal pulmonary embolism
Authors: Sridhar Arani V , Naveen Rao K , Chakraborty Supratik
Published: August 2010

Pulmonary thromboembolism is rarely recognized in young children, even in hospital settings. All current management decisions for children with deep vein thrombosis (DVT) are directly extrapolated from treatment recommendations for adults with no further validation. We report the case of a 6‐y‐old child presenting with deep vein thrombosis of the leg veins and fatal pulmonary embolism. The fatal outcome in our case highlights the need for more epidemiological studies in children, not only to predict the recurrence of pulmonary emboli but also to prepare standard treatment guidelines for the management of DVT and pulmonary emboli in children. We speculate that there may be a role for temporary inferior vena cava filters in young children with extensive DVT of the legs.

Conclusions: This case highlights the need for more epidemiological studies to predict the recurrence of pulmonary emboli and effective guidelines for the management of paediatric DVT and pulmonary emboli in children.
Dysmetabolic syndrome in childhood and adolescence
Authors: Bitsori Maria , Kafatos Anthony
Published: August 2010

The dysmetabolic syndrome, consisting of dyslipidaemia, hypertension, hyperinsulinaemia and central obesity, has been well recognized as a major risk for cardiovascular disease in adults. Although the clustering of cardiovascular risk factors has also been identified in childhood, the occurrence of full‐blown dysmetabolic syndrome at younger ages has only recently been investigated. In this article we attempted an overview of the data for children and adolescents, focused on the mechanisms and natural history of the disease, the prevalence among paediatric populations, the assessment and the treatment approaches.

Conclusion: There is substantial evidence that the dysmetabolic syndrome has its origins in childhood. In the face of the epidemic increase of obesity in children and adolescents, the development of effective screening and preventive strategies would be a major challenge for paediatricians.
Thyroid dysfunction in the offspring of mothers with autoimmune thyroid diseases
Authors: Péter Ferenc
Published: August 2010

An integrated three‐compartment thyroid model exists during gestation: pregnancy influences thyroid function in several ways, the placenta plays an active role in TRH–thyroid and iodide transport and metabolism, and the fetus develops its own hypothalamic–pituitary–thyroid axis. This commentary reviews some basic and new data, especially in the maternal–offspring relationship in the case of maternal autoimmune thyroid diseases.

Conclusion: The careful control of maternal autoimmune thyroid disease is essential in order to avoid pathological changes in the offspring.
Growth tracking of femoral and humeral strength from infancy through late adolescence
Authors: Ruff Christopher
Published: August 2010

Aim: To determine to what degree femoral and humeral strengths “track”, or remain at the same ranked position relative to other individuals during the entire growth period. Methods: Radiographs of 20 individuals, equally divided by sex, were measured at 6‐mo or annual intervals from 6 mo to 17 y of age. The section modulus, a measure of bending/torsional strength, was derived from cortical and subperiosteal breadths taken at the femoral midshaft and at 40% of the bone length from the distal end of the humerus. Body size was also assessed as the product of body weight and bone length. Growth tracking was evaluated in two ways: as Spearman rank‐order correlations between strengths at each age point and strengths at 17 y of age, and as the number of individual changes in rank over specified age intervals. All analyses were carried out within sex. Results: The degree of growth tracking varied by sex, skeletal location, and age. Correlations were higher for the humerus (r=0.56–0.83) than for the femur (r=0.10–0.63). Males showed particularly poor tracking for the femur, most likely due to late and variable adolescent growth spurts in body size. Standardizing for body size improved tracking for the male femur, but not for the humerus. Over the entire growth period, individuals averaged 5–8 out of a possible 9 changes in rank. Early childhood (<6 y) was the least stable period.

Conclusion: Previously documented growth tracking of skeletal parameters over relatively short (1–6‐y) time periods can not necessarily be extrapolated to longer time intervals, nor can results from one skeletal region or time period be applied to another region or time period. Variation in timing of growth events, and body size for weight‐bearing elements, may have important influences on growth tracking.
Severe hypothyroidism due to atrophic thyroiditis from second year of life influenced developmental outcome
Authors: Joergensen JV , Oerbeck B , Jebsen P , Heyerdahl S , Kase BF
Published: August 2010

From the second year of life a girl showed an insidious development of clinical hypothyroidism due to a non‐goitrous lymphocytic thyroiditis without traceable circulating levels of thyroid antibodies measured by routine immunoassays. The diagnostic delay of this rare variant of atrophic thyroiditis caused persistent neuropsychological deficits.

Conclusion: Her difficulties with speed of processing and working memory in particular could suggest a frontal deficit, possibly in the dorsolateral prefrontal circuit. This contrasts with findings in congenital hypothyroidism, suggesting a relatively preserved frontal function, and could illustrate different neuropsychological deficits of hypothyroidism at different ages in early childhood.