bluuebunny/crossref_metadata_2025 huggingface dataset:
Idiopathic gastric rupture in a 3‐month‐old girl
Authors: Shimizu T , Horiuchi T , Hirooka S , Yonekura T , Tamai H
Published: August 2010

This case reports on idiopathic gastric rupture in a 3‐mo‐old girl who had frequent episodes of vomiting and abdominal distension the day before admission to the clinic. Metabolic acidosis was detected and rotavirus antigen was identified in the stools. Abdominal X‐rays and CT scans revealed free air and fluid in the abdominal cavity, leading to a diagnosis of gastrointestinal perforation. During surgery, idiopathic gastric rupture was detected and treated. The postoperative course was uneventful.

Conclusion: Idiopathic gastric rupture is extremely rare in childhood beyond the neonatal period. Early diagnosis and surgery are mandatory if children with this condition are to be saved.
Why do we help a micropreemie to live?
Authors: Takahashi S , Endo A , Minato M
Published: August 2010

Helping a “micropreemie” to live by aggressive interventions may sometimes seem unnatural. However, utilitarian assessment of benefits derived from lifesaving efforts for a micropreemie is considered inappropriate. The goal in treating premature infants has advanced from fetal salvage to achieving “intact survival”, which represents a new therapeutic target. In this way, the record for lifesaving in extremely low‐birthweight infants is continually being broken. Why do we help a micropreemie to live? Moral and ethical emotions are the underlying reasons for the aggressive care devoted to premature infants, including micropreemies. Such human feelings might even be considered the purpose of life. Human emotion is the impetus for aggressive efforts to improve the survival prospects of premature infants. The beautiful and delicate nature of a newborn is compelling. The high‐order emotion of empathy for another's misfortune is also important. Most human emotions are related to an awareness of death, and micropreemies are near death. In Oriental thought, a human being is a growing product of nature. Forces of nature and changes in a living being follow nature's rules. First and foremost, an individual life is part of the long chain of existence beginning before the self and continuing beyond it. An immature human being, even a newborn, is simultaneously a complete entity and part of nature's long chain of being, which has a wholeness of its own that affirms a micropreemie's right to life. A fetus is a member of human society in the sense that there is an overall reverence for life as a quality that lives on.

Conclusion: The limit that bioethics must not exceed is the sanctity of life. We believe that the birth of a micropreemie is an important and serious event. We profoundly wish that a micropreemie might live and thrive, because we on earth must live with the continual presence and imminence of death.
Fatty acids in formulae for term infants: compliance of present recommendations with the actual human milk fatty acid composition of geographically different populations
Authors: Smit EN , Martini IA , Kemperman RFJ , Schaafsma A , Muskiet FAJ , Boersma ER
Published: August 2010

Aim: Recommendations for formula fatty acids (FA) are largely based on the mature human milk FA composition. This study aimed to investigate whether current recommendations for formula FA for term infants comply with the actual breast‐milk FA composition of geographically distinct populations and to provide more realistic grounds for future recommendations.Methods: 455 mature breast‐milk samples were collected in different countries over 25 y. Recommendations of different organizations were projected on their FA data. FA interrelationships were calculated with Spearman's rank tests. FA compositions of 30 formulae were compared with those of breast milk.Results: Many samples from non‐Western communities did not meet the recommendations for formula 12:0, 14:0 and 18:2ω6, since these are mainly based on breast milk of mothers living in Western countries. Recommendations for 18:3ω3, 18:2ω6/18:3ω3, 20:4ω6 and 22:6ω3 were not met by many milk samples, which may point to the poorly developed recommendations for long‐chain polyunsaturated FA. Most of the investigated breast‐milk FA (12:0, 14:0, 16:0, 18:0, 18:3ω3, 22:6ω3, 18:2ω6, 20:4ω6, 18:lω9) were either positively or negatively interrelated. Many formulae had FA compositions that were not consistent with the physiological interrelationships of FA in breast milk.Conclusion: Future recommendations, if based on human milk, should derive from its FA balance, as indicated by the FA interrelationships. A “humanized” formula FA composition would in this sense be any composition that cannot be distinguished from that of breast milk by techniques such as principal component analysis.
Psychosocial distress during pregnancy and the risk of infantile colic: a follow‐up study
Authors: Søndergaard C , Olsen J , Friis‐Haschè E , Dirdal M , Thrane N , Sørensen H Toft
Published: August 2010

Aim: To examine the association between psychosocial exposures during pregnancy and the risk of infantile colic. Methods: The study included 378 infants and was conducted as a substudy of the Danish National Birth Cohort from 1997 to 1999, with prenatal data collected twice during pregnancy. A diary with a record for postpartum weeks 4–8 was used to quantify the amount of the infants' crying and fussing. Results: The cumulative incidence proportion of infantile colic was 8.2%. A threefold increased risk of infantile colic (OR = 3.7; 95% CI: 1.1–13.2) was found for mothers who reported distress during pregnancy. Close to a twofold increased risk of IC was found for the women who scored higher than 8 on the psychological distress scale (adjusted OR = 1.9; 95% CI: 0.5–7.2).

Conclusion: The results indicate that general distress during pregnancy influences the risk of infantile colic. Whether or not this relationship is causal requires further investigations.
Seven‐year review of paediatric bacteraemias diagnosed in a Spanish university hospital
Authors: López A Pérez , Giménez M , Rodrigo C , Alonso A , Prat C , Ausina V
Published: August 2010

This study analysed the clinical and bacteriological patterns of paediatric bacteraemia in a university hospital, by a review of 213 episodes over a period of 7 y. Streptococcus pneumoniae was the most frequent aetiological agent after the neonatal period and Streptococcus agalactiae in neonatal sepsis. Almost half of pneumococci and meningococci were penicillin non‐susceptible. Four neonatal deaths attributed to bacteraemia were recorded.

Conclusion: Streptococcus pneumoniae is the leading cause of community‐acquired bacteraemia. Mortality due to bacteraemia in children without underlying conditions is rare.
Partial trisomy 22 resulting from rearrangements between chromosomes 11/22 and 16/22: a report of two cases
Authors: Werding N , Holland H , Hueckel D , Froster UG , Häusler HJ , Kiess W
Published: August 2010

Two male infants with partial trisomy 22 resulting from a rearrangement between chromosomes 11/22 and 16/22 were admitted to the Children's Hospital of the University of Leipzig within the space of two months. The characteristic phenotype of the infants is described and compared with the data on liveborn infants with trisomy 22, as reported in the literature. One of the infants reported here showed a prenatally detected hygroma colli. To the best of our knowledge this is the first description of a hygroma colli in this chromosomal disorder.

Conclusion: Infants with trisomy 22 can present with variable phenotypes. It is important to bear the phenotype of chromosome 22 infants in mind.
Does circadian variation in risk factors for sudden infant death syndrome (SIDS) suggest there are two (or more) SIDS subtypes?
Authors: Mitchell EA , Williams SM
Published: August 2010

Sudden infant death syndrome (SIDS) is known to occur more frequently at night. In two studies it has now been shown that a prone sleep position is more strongly associated with SIDS occurring during the day, whereas night‐time deaths are more strongly associated with maternal smoking and illness.

Conclusion: This variation, although unexplained, does suggest at least two SIDS subtypes: one related to sleep position and possibly a thermal mechanism, and one related to an uncontrolled inflammatory response to infection predominantly occurring at night. In addition, there are probably other mechanisms that do not show a circadian variation.
Identifying children at risk for language impairment: screening of communication at 18 months
Authors: Lacerda F
Published: August 2010

The difficulties of early identification of children at risk for language impairment are discussed against a background of other more or less important phenomena.

Conclusion: Bruce et al.'s professional screening at 18 mo provides relevant information to detect children at risk for language impairment.
Children and statins
Authors: Tonstad S
Published: August 2010

Use of statins is increasing among children with familial hypercholesterolaemia who previously have had to take unpalatable resins. In a selected group with no controls, children taking statins had similar scores for quality of life and anxiety as normative scores. The question that remains is how to improve dietary and disease information.

Conclusion: Children with familial hypercholesterolaemia who are taking statins have no reduction in quality of life or increase in anxiety.
Oesophageal pH monitoring in children: how is it perceived by the parents and does the technique change feeding and daily activity?
Authors: Arana A , Hauser B , Hegar B , Kaufman L , Vandenplas Y
Published: August 2010

Aim: To determine whether oesophageal pH monitoring in infants induces changes in daily activity and feeding, and with the help of a questionnaire to evaluate how parents perceive pH monitoring. Methods: The parents of 100 children, consecutively referred for oesophageal pH monitoring, were asked by one of the authors (A.A.) to respond to a standardized questionnaire immediately after the end of the procedure. Twenty questions were asked, concerning five topics: feeding (4 questions), activity (6 questions), perception of the parents (6 questions), accuracy of the provided information (3 questions), and previous experience with oesophageal pH‐metry (1 question). For statistical analysis, every variable was qualified as “no change” and “change” for feeding and activity, as “positive” or “negative” regarding the perception of the test, and as “sufficient” or “insufficient” regarding the information provided. The answers to the questions were also analysed according to the result of the oesophageal pH monitoring (normal vs abnormal), and according to whether or not there was previous experience of oesophageal pH‐metry in a first degree relative. Results: Changes in feeding occurred in 28% of cases and changes in activity in 30%, but did not differ according to the oesophageal pH‐metry result. Equally, the perception of the parents regarding the test (37% negative), the acceptability of a second pH‐metry test (refusal in 52%) and previous experience with oesophageal pH‐metry (positive in 25%) were not influenced by the result of the pH monitoring. Parents of infants with abnormal oesophageal pH monitoring were more frequently dissatisfied with the information about the nature of the test provided before the test and also the results than parents of infants with normal results (52% vs 19%, respectively; p < 0.05).

Conclusion: According to the perception of the parents, pH monitoring induces changes in feeding and activity in 28% and 30%%, respectively; 63% of the parents considered pH monitoring to be well tolerated. Parents of infants with abnormal pH monitoring results need more attention.
Pubertal growth and development in cystic fibrosis: a retrospective review
Authors: Aswani N , Taylor CJ , McGaw J , Pickering M , Rigby AS
Published: August 2010

Aim: Normal growth patterns are seen throughout the first decade in children with cystic fibrosis (CF). Growth in the second decade is, however, less satisfactory and may reflect pubertal delay. This study was performed to assess the extent of pubertal delay, to examine factors that influence the timing and magnitude of the pubertal growth spurt, and to establish whether the final height for most CF patients differed significantly from the normal population. Methods: Thirty subjects (16 male) attending a single centre were studied. Peak height velocity (PHV), final height and ages when achieved were compared with population norms. Outcome data were correlated with disease severity using Shwachman and Chrispin‐Norman scores and forced expiratory volume in 1 s. Results: PHV was significantly later in both genders in this CF population compared with Tanner and Whitehouse standards: boys 14.6 y (95% confidence interval (95% CI) 12.4–16.8, p < 0.01) and girls 12.6 y (95% CI 10.5–14.7, p < 0.01). Mean PHV was also lower in both genders (boys 7.7 cm y−1 and girls 6.4 cm y−1, both p < 0.001). However, final heights did not differ significantly from Freeman standards (height standard deviation scores: males–1.2, females–0.1); 52% of final heights equalled or exceeded the mid‐parental centile.

Conclusion: CF patients showed suboptimal PHVs with a later pubertal growth spurt influenced by disease severity, but eventually achieved a normal final height.
Improved final height in Turner's syndrome following growth‐promoting treatment at a single centre
Authors: Gault EJ , Paterson WF , Young D , Donaldson MDC
Published: August 2010

Aims: To examine the final height (FH) outcome of girls with Turner's syndrome (TS) treated at a single Scottish centre (Glasgow group), to compare it with an earlier national analysis (Scottish group) and to suggest reasons for any change. Methods: Retrospective growth and treatment data for 29 Glasgow patients were compared with those of 26 Scottish patients. Results: Age at GH start (mean ± SD) was 10.1 ± 2.6 vs 12.1 ± 1.7 y (p < 0.01) in the Glasgow versus Scottish groups, with overall duration of treatment 6.2 ± 2.4 vs 3.7 ± 1.1 y (p < 0.001) and years of GH treatment before pubertal induction 2.7 ± 2.8 vs 0.3 ± 0.8 y (p < 0.001), respectively. Pubertal induction was at a similar age: 12.7 ± 1.8 vs 12.8 ± 1.8 y (ns). FH was 151.1 ± 4.6 cm in the Glasgow group compared with 142.6 ± 5.6 cm in the Scottish group (p < 0.001), with FH ‐projected adult height (PAH) 5.7 ± 4.6 cm vs 0.6 ± 3.6 cm (p < 0.001), respectively. Univariate analysis of the Glasgow group's FH – PAH with a number of growth and treatment variables identified no statistically significant relationships.

Conclusion: This group's improved FH and FH – PAH, relative to an earlier sample, are attributed to the introduction of GH treatment from a younger age and for longer, overall and before pubertal induction. In addition, the authors believe that compliance with treatment has been enhanced by this single centre's dedicated Turner clinic and the efforts of its established “growth team”. These data demonstrate that a favourable FH can be achieved using a safe and financially viable dose of GH, while inducing puberty at a “normal” age.
Identifying children at risk for language impairment: screening of communication at 18 months
Authors: Bruce B , Kornfalt R , Radeborg K , Hansson K , Nettelbladt U
Published: August 2010

Aim: To investigate the possibility of identifying children at risk for language impairment based on a new screening instrument to assess communication and language skills at 18 mo of age. Methods: At 18 mo, 58 children were assessed with a screening instrument for communication and language consisting of a professional assessment and a parents' questionnaire. Students of speech and language pathology, well trained in child language assessment, carried out the professional assessment, which was based on observations of play behaviour, interaction and expressive and receptive language skills. Of the 58 children, 43 attended a follow‐up assessment of language skills at 54 mo of age. Results: Nine children were considered to be at risk for language impairment at 18 mo and 10 children were evaluated as being at risk at 54 mo. A significant positive correlation was found between the professional evaluations at 18 mo and the language tests at 54 mo. Verbal comprehension and pretend play correlated significantly with the results on the language tests.

Conclusion: A professional screening of communication and language at 18 mo of age is worthwhile for predicting problems in language development. The results further show that language comprehension and pretend play rather than expressive skills should be emphasized.
Pregnancy and childbirth‐related factors associated with recurrent antibiotic use in infants
Authors: Louhi‐Pirkanniemi KA , Rautava PT , Aromaa M , Ojanlatva AT , Mertsola J , Helenius H , Sillanpää ML
Published: August 2010

Aim: To determine the reasons for the possible overuse of antibiotics by investigating whether family‐related medical, behavioural, emotional, and social risk factors during the mother's pregnancy and childbirth are associated with subsequent recurrent antibiotic therapy of infants. Methods: Subject selection was based on stratified randomized cluster sampling. A total of 1443 women (91%) and their spouses expecting their first child gave informed consent to participate and 1287 infants were born. The parents of 817/1025 infants (80%) reported the number of courses of antibiotic therapy the child had Received at the ages of 9 and 18 mo. The outcome measure was the number of courses of antibiotic therapy (none/1–5/= 6) given during the first 18 mo of life. The explanatory variables included family‐related factors during the pregnancy and immediately after childbirth. Results: In the final multivariate stepwise analysis, parents' long‐term illnesses were associated with recurrent antibiotic medication.

Conclusions: Parents with long‐term illnesses need special guidance and support from the beginning of the mother's pregnancy in order to minimize the subsequent risk for recurrent antibiotic therapy of their infants. Preventive healthcare workers should be aware of the effects of these factors on parental guidance.
Coronary arteries in fetal life: physiology, malformations and the “heart‐sparing effect”
Authors: Chaoui R
Published: August 2010

The present knowledge of coronary arteries in prenatal diagnosis is reviewed with a focus on three aspects: the physiology and visualization of coronary flow, malformations involving the coronary arteries, and the “heart‐sparing effect”. Visualization of coronary arteries in a healthy human fetus is possible in real‐time and colour Doppler during the last 10wk of gestation when ultrasound conditions are excellent. Visualization at an earlier gestational age (up to 13 wk) is feasible mainly in association with malformations and impending hypoxia. The main coronary malformations that can be visualized in utero are the ventriculo‐coronary communications in fetuses with pulmonary atresia. In the last few years, interest has been focused on the “heart‐sparing effect”, defined as the increased perfusion of the coronary arteries in fetuses with severe growth restriction and abnormal Doppler velocimetry in the peripheral vessels. Increased perfusion detectable with colour and pulsed Doppler is a late sign of fetal compromise in hypoxaemia. It confirms animal experiments that have demonstrated dilatory reserves of the fetal coronary arteries under chronic hypoxaemia. The outcome of 21 fetuses showing the “heart‐sparing effect” before 32 wk gestation was poor: nine fetuses died in utero and two after birth, the median weight at birth was 630 g.

In summary, our knowledge of the coronary arteries in the fetus is based on the diagnostic means used in prenatal diagnosis. New information in this field may also contribute to a better understanding of coronary heart disease later in life.
Coronary flow and flow reserve in children
Authors: Óskarsson G
Published: August 2010

Aortic blood pressure affects coronary blood flow, but within the normal physiological blood pressure range coronary blood flow is constant. The coronary flow is pulsatile, being maximal in the early diastole. There is a smaller systolic flow component. The low systolic pressure in the right ventricle favours systolic flow. The proportion of systolic flow is greater in the right than in the left coronary artery. Heart diseases in children cause several haemodynamic and functional changes that are likely to affect myocardial perfusion. Newborns with severe valvular aortic stenosis may have a retrograde systolic flow in the left coronary artery. Children with dilated cardiomyopathy have a reduced coronary flow related to myocardial mass. Coronary flow reserve (CFR) is defined as the ratio of maximal coronary blood flow, as induced by reactive hyperaemia or administration of vasodilators, divided by resting flow. Coronary flow can normally increase 2.5–4‐fold. CFR is reduced if basal flow is increased due to myocardial hypertrophy, strain or hypoxaemia. Very low CFR values measured with positron emission tomography are reported in neonates with surgically treated congenital heart disease. Measurement of coronary flow velocity with the intracoronary Doppler guide wire may be regarded as a reference or “gold standard” in the evaluation of coronary flow velocity and CFR.

Conclusions: Coronary flow and CFR in children is a largely unexploited field, and has vast potential for future research.
Endothelial cell function testing: how does the method help us in evaluating vascular status?
Authors: Halcox JPJ , Deanfield JE
Published: August 2010

Vascular endothelial dysfunction describes a phenotype prone to atherogenesis and clinical complications of this disease process. Endothelium‐dependent vasodilator function, reflecting local bioavailability of nitric oxide, can be measured clinically in the peripheral and coronary circulation and corresponds with other measures of endothelial biology including inflammatory status and thrombotic tendency. Although conventional risk factors are key determinants of endothelial dysfunction, many other factors, including the individual's genetic profile, also appear to exert important positive and negative functional influences. Thus, endothelial vasodilator function can be regarded as an integrated index of all atherogenic and atheroprotective factors acting on the vascular wall, reflecting underlying biology and inherent atherosclerotic risk. The potential clinical utility of endothelial vasomotor testing as a prognostic tool in risk assessment and for the monitoring of therapy requires further validation before recommending its wider routine use.
Atherosclerosis and the immune system
Authors: Hansson GK , Berne G Paulsson
Published: August 2010

The immune system is involved at all stages of the atherosclerotic disease process. Innate immunity, represented by macrophages and other cells, is directly activated by microbial components and possibly also by autologous lipids and proteins. It elicits inflammatory activity, which is a key component of the atherosclerotic lesion. Adaptive immunity is initiated by recognition of disease‐related antigens, which include oxidatively modified lipoproteins, heat shock proteins and microbial macromolecules. In the artery wall, adaptive immune recognition mainly leads to Th1 effector responses, which are characterized by secretion of proinflammatory cytokines and by activation of macrophages and vascular cells. Therefore, both the innate and adaptive arms of the immune system lead to inflammation in the developing atherosclerotic lesion. Interestingly, several effector pathways of cellular as well as humoral immunity tend to counteract proatherogenic, proinflammatory immunity. The notion that immunity plays an important role in the development of atherosclerosis has focused attention on a number of potential novel targets for intervention based on modulation of such immune responses.
Magnetic resonance measurement of coronary blood flow
Authors: Sakuma H , Higgins CB
Published: August 2010

Magnetic resonance (MR) flow measurement in the coronary artery can be achieved with either a breath‐hold acquisition or a respiration‐triggered acquisition. MR measurements of cardiac output are significantly depressed during breath‐holding at deep inspiration, but the advantage is that the breath‐hold method requires less scan time. Blood flow in the coronary sinus reflects the global myocardial blood flow because it represents approximately 96% of the total myocardial blood flow of the left ventricle (LV). If blood flow in the coronary sinus is measured with phase‐contrast cine magnetic resonance imaging (MRI) and LV myocardial mass is measured with cine MRI, both the total myocardial blood flow and the average coronary blood flow per gram of myocardial mass can be quantified. Coronary flow reserve with volumetric MR flow measurement is measured to be within 4.2–5.0‐fold. The noninvasive MR measurement of coronary flow reserve has been shown to be useful in identifying the functional significance of stenoses in the left anterior descending artery. The sensitivity and specificity of MR coronary flow velocity reserve for identifying stenosis of 70% or greater in the left main or left anterior descending artery were 100% and 83%, respectively. The MR quantification of total coronary blood flow and coronary blood flow per gram of myocardial mass seems to be an ideal method for evaluating coronary hemodynamics and may be useful in evaluating endothelial dysfunction of the coronary circulation.

Recent advances in fast MRI sequences have considerably extended the capabilities of cardiac MRI in the functional assessment of coronary blood flow and flow reserve. The MR measurement of coronary flow reserve can be used to identify restenosis of the left main and left anterior descending coronary arteries after percutaneous interventions in clinical patients. Further refinements in MR pulse sequences, including the use of phase‐contrast echo‐planar or spiral MR methods, may make it possible to quantify blood flow volume and flow reserve more accurately in all major branches of the coronary arteries.

The MR measurement of blood flow through the coronary sinus allows a noninvasive assessment of global coronary hemodynamics. Because the coronary sinus is larger than the native coronary arteries, the errors in blood flow quantification associated with the limited spatial and temporal resolution of current phase‐contrast MR sequences are substantially smaller. The MR quantification of total coronary blood flow and coronary blood flow per gram of myocardium during stress and at rest seems to be an ideal method for evaluating coronary hemodynamics in diffuse myocardial diseases of the heart, such as hypertensive heart diseases and cardiomyopathies, and may be useful in evaluating endothelial dysfunction of the coronary circulation, which develops in the earliest stages of atherosclerotic disease and may precede obstruction of the epicardial coronary arteries.
Orphaned and vulnerable to infection, undernutrition and early death: increasing threats to infants and children
Authors: Gracey M
Published: August 2010

Infants and young children in Guinea‐Bissau who were made motherless had much higher mortality rates than a control group of subjects. Child mortality was higher in rural than urban children and was highest under 2 y of age and within 6 mo of their mothers' deaths. The authors of this study, which appears elsewhere in this issue, suggest that premature weaning may contribute to this excess mortality.

Conclusion: There are many causes of maternal mortality that can lead to motherlessness among infants and children, particularly in developing countries. Multifaceted approaches to the care of these children are needed to lessen their excessive mortality. Paediatricians have a potentially very important role in preventing this burden of childhood ill‐health and deaths.
Sodium handling in congenitally hypothyroid neonates
Authors: Asami T , Uchiyama M
Published: August 2010

Early observations emphasized the possible development of hyponatraemia in hypothyroid children and adults, but recently this has been questioned. Aim: To investigate whether hyponatraemia develops in hypothyroid status by examining sodium handling in screening‐detected neonates and infants with congenital hypothyroidism (CH). Methods: Serum thyroid‐stimulating hormone (TSH), free thyroxine (FT4), sodium (Na), creatinine (Cr), urinary Na, Cr, fractional sodium excretion rate (FENa) and other chemicals were measured before and after L‐thyroxine (LT4) replacement therapy in 32 screening‐detected CH neonates (11M, 21F) and 16 age‐matched control neonates. Results: No cases of hyponatraemia were found in the 32 CH neonates. Their serum Na concentrations (139.1 ± 1.5mmol/L, ranging from 136 to 142mmol/L, median 139mmol/L) were not statistically different from those of 16 control neonates (139.3 ± 1.3 mmol/L, ranging from 137 to 142 mmol/L, median 139 mmol/L,). No correlation was found between serum levels of TSH and FT4 and serum Na or FENa. No significant changes were found in serum Na concentrations in hypothyroid neonates two months after LT4 replacement therapy. The serum Na concentration (139.1 ±0.3 mmol/L, n= 25) before treatment did not change statistically (138.9 ± 0.2 mmol/L, n= 25) two months after LT4 replacement therapy.

Conclusion: As seen in various earlier reports, hyponatraemia can occur in hypothyroid patients, but no causal relationship exists between them. When hyponatraemia is detected in hypothyroid children, it does not seem to be directly related to lack of thyroid hormones and therefore other possible causes should be sought.
Neurovesical dysfunction in children after surgery for high or intermediate anorectal malformations
Authors: de Medina V Hulthén , Mellstam L , Åmark P , Frenckner B
Published: August 2010

Aim: To evaluate problems with bladder dysfunction in patients operated on for imperforate anus. Methods: All patients (11M, 25F) with high or intermediate imperforate anus seen in this institution between 1987 and 1997 were subjected to the investigation. They had all undergone a posterior sagittal anorectoplasty procedure with the aim of preserving as much as possible of the fistula. Hospital charts were reviewed. A detailed and structured interview regarding micturition habits was performed. If the results of this were abnormal the patients were also subjected to flow registration, measurements of residual urinary volume and in some cases also cystometry. Results: Micturition habits were normal in 30 out of 36 children. The remaining six, considered to have neurovesical dysfunction (NVD), had difficulties in emptying their bladder and exhibited pathological residual volumes. Two were boys with rectourethral fistulae, two were girls with cloacal malformations and two were girls with rectovestibular fistulae. Four out of six children with NVD had sacral anomalies.

Conclusion: NVD may occur even in the absence of sacral anomalies. A 4h micturition observation is recommended in all newborns with intermediate or high anorectal anomalies to recognize the occurrence of NVD at an early stage.
Inhaled nitric oxide improves oxygenation in very premature infants with low pulmonary blood flow
Authors: Desandes R , Desandes E , Droullé P , Didier F , Longrois D , Hascoët JM
Published: August 2010

Aim: Inhaled nitric oxide (iNO) is used to reduce right‐to‐left extrapulmonary shunting by decreasing pulmonary vascular resistance in term or near‐term infants. The objectives of this study were to determine, first, the pulmonary blood flow status of very preterm infants with hypoxaemic respiratory failure, then the response of oxygenation to iNO therapy according to pulmonary blood flow (PBF) and, finally, to verify the lack of adverse side effects of iNO on the ductus arteriosus. Methods: Infants below 32 wk gestational age (GA) with hypoxic respiratory failure and aAO2 < 0.22 were randomized as the control or iNO group. PBF was evaluated by pulsed Doppler measurement of mean pulmonary blood flow velocity (MPBFV) in the left pulmonary artery. Low PBF (LPBF) was defined as MPBFV >0.2m/s. Results: Seventy infants of 23 to 31 wk GA with hypoxic respiratory failure were randomized either to receive or not to receive 5 ppm iNO in addition to optimal care. Twenty‐eight infants were diagnosed with LPBF (11/35 in iNO vs 17/35 in the control groups). Thirty minutes after receiving iNO the number of LPBF infants dropped to 8/35. In the iNO group, aAO2 increased significantly from 0.14 ± 0.05 to 0.24 ± 0.08 after iNO, but only in the LPBF infants (mean ± SD; p= 0.027).

Conclusion: In infants below 32 wk GA with hypoxic respiratory failure, Doppler echocardiographic assessment of LPBF seems to be able to determine which patients are likely to benefit from iNO therapy on systemic oxygenation.
Brainstem auditory‐evoked responses to different rates of clicks in small‐for‐gestational age preterm infants at term
Authors: Jiang ZD , Brosi DM , Wang J , Wilkinson AR
Published: August 2010

Aim: To clarify further the influence of intrauterine growth retardation (IUGR) on early neural development. Methods: In 30 small‐for‐gestational age (SGA) preterm infants at term, brainstem auditory‐evoked responses (BAERs) were recorded with clicks of different repetition rates. All infants had a birthweight >3rd centile, without any other major perinatal complications. Results: Compared with the BAER in 36 appropriate‐for‐gestational age (AGA) term infants, the preterm SGA infants did not show any abnormalities at 21 s−1 clicks, except for a slight increase in wave III amplitude. At 51 s−1 clicks, there was an increase in III–V/I–III interval ratio (ANOVA p < 0.05). At 91 s−1, the I–III interval shortened, whereas the III–V interval and III–V/I–III interval ratio increased (all p < 0.05). Wave V amplitude tended to increase slightly at all repetition rates of clicks used, although this increase did not reach statistical significance. The III–V interval and III–V/I–III interval ratio in the preterm SGA infants at different click rates correlated inversely with occipitofrontal head circumference at the time of testing, i.e. the smaller the head the longer the III‐V interval (all p < 0.01). Wave III amplitude at 21 s−1 also correlated inversely with head circumference (p < 0.01), suggesting that the slight increase in this amplitude in the preterm SGA infants is related to their relatively small head size.

Conclusion: There were no major abnormalities in the BAER up to 91 s−1 clicks at term in preterm SGA infants. The slight increase in III–V interval at high‐rate stimulation suggests a subtle degree of central neural dysfunction, which is associated with small head size following IUGR.
Low prevalence of complications of delayed herniotomy in the extremely premature infant
Authors: Santacruz M González , Navarro J Mira , Goenechea A Encinas , Ceballos A García , Zaplana H Sánchez , Cobo B Jiménez
Published: August 2010

Aim: To study the relationship between the delay of herniotomy in the extremely premature infant and the rate of complications in comparison with full‐term children. Methods: A follow‐up study of three groups of neonates operated on for inguinal hernia was performed. The groups were defined as: a) the short‐waiting group (SWG): prematures (mean gestational age: 32.56 ± 0.62; n= 9) operated on within 2 wk of diagnosis (median: 5 d); b) the long‐waiting group (LWG): prematures (mean gestational age: 28.38 ± 1; n= 21) operated on after more than 2 wk (median: 39 d); and c) control group of full‐term children (FTG); (mean gestational age: 38.18 ± 0.29; median of timing: 3d; n= 11). Several variables (gestational age, weight at birth and at surgery, side of the inguinal herrnia, timing, duration of surgery, type of anaesthesia, length of hospitalization), as well as the occurrence of apnoea, incarceration and testicular atrophy were compared between groups. Results: Timing was the only variable that was different between the LWG and the other two groups (p < 0.001, ANOVA). Seven preoperative episodes of incarceration occurred: one in the SWG, two in the LWG and four in the FTG (p= 0.138, χ2). In the follow‐up study two testicular atrophies, related to previous episodes of incarceration, were found: one in the FTG and the other in the SWG (p= 0.221, χ2).

Conclusion: The deferral of herniotomy in the extremely premature infant, until the child is ready to be discharged from the neonatal unit, does not seem to increase the risk of incarceration episodes or testicular atrophy.
Maternal and neonatal factors and mortality in children with Down syndrome born in 1973–1980 and 1995–1998
Authors: Frid C , Drott P , Olausson P Otterblad , Sundelin C , Annerén G
Published: August 2010

Aims: To investigate maternal and neonatal factors in Down syndrome (DS) at birth, the impact of a congenital heart defect (CHD) on these factors and changes over time. Methods: Medical data of children with DS born in northern Sweden in the periods 1973–1980 (n= 219) and 1995–1998 (n= 88) obtained from the Swedish Medical Birth Register were compared. A comparison with the general population on a group level was also made. Results: The main finding was a reduction in infant mortality in DS, from 14.2% to 2.3% in 1995–1998 (p < 0.001), but this was still significantly higher than in the general population. The rate of Caesarean sections increased over time (from 14.5% to 27.3%, p < 0.05) even after adjustment for increased maternal age. No change over time was detected in the following rates: premature birth (gestational age ±36) (25%); asphyxia (5‐min Apgar score ±6) (8%); low birthweight (<2500g) (14%); or small for gestational age (SGA) (14%); all rates were significantly higher than those of the general population. A CHD did not seem to influence the rates of these factors in a logistic regression model.

Conclusion: Infant mortality decreased substantially over time in the DS group, whereas there was no reduction in the rate of asphyxia, SGA, low birthweight or prematurity. The presence of a CHD did not influence any of the neonatal factors studied.
Treatment of sleep problems in families with young children: effects of treatment on family well‐being
Authors: Eckerberg B
Published: August 2010

Aim: To evaluate a standardized sleep programme that is a two‐step variation of graduated extinction, where the child is first taught to fall asleep by him/herself at bedtime (first intervention) and two weeks later also after night awakenings (second intervention). As it has been claimed that extinction procedures may be harmful to the child, this study documents both night‐ and daytime behaviour before and after interventions. Method: The study included a total of 95 families, with children from 4 to 45 mo of age exhibiting frequent signalled awakening episodes during the night. Sleep diaries, visual analogue scales (VAS) on daytime behaviour and the Flint Infant Security scale, completed by parents, were used as instruments. Parents also completed VAS scales and the Swedish Parenthood Stress Questionnaire scales on their own well‐being. Results: All families carried out the interventions. Parents reported significant improvements in sleep quality, daytime behaviour and family well‐being as early as two weeks after the first intervention. Before intervention, the sleep‐disturbed children were rated as more insecure than a matched comparison group with unknown sleep behaviour. This difference was eliminated after the interventions. The more anxious the children were rated before intervention, the more they tended to benefit from it.

Conclusion: If parents experience young children's night awakenings as a problem, teaching the children to fall asleep by themselves usually solves this problem quickly. According to parental ratings, family well‐being and negative daytime behaviour are also improved
Tubulo‐interstitial nephritis and uveitis syndrome associated with mastitis: a case report
Authors: Voghenzi A , Mattiuzzo M , De Rosa E , Stabellini N
Published: August 2010

A new case of tubulo‐interstitial nephritis and uveitis (TINU) syndrome in a 14‐y‐old girl is described. In this patient unilateral mastitis was an associated feature. The aetiology of this rare syndrome, the prognosis for which is usually good, is still unknown. The most common theory supports a cell‐mediated immune response induced by infectious/antigenic stimuli.

Conclusion: The presence of acute unilateral mastitis in this patient may represent an additional localization in TINU syndrome.
Is intensive care for very immature babies justified?
Authors: Levene M
Published: August 2010

Neonatal intensive care is generally considered justified in the majority of very premature infants, but there is some concern about the effectiveness of the techniques used at the margins of viability (22–24 wk of gestation). The controversy that exists in this area is largely due to a lack of agreed endpoints for geographically based populations where all live births are considered. Evaluation of outcome must also take the quality of neurological function in surviving infants into consideration, and in reviewing these data the reader is struck by the few reports providing information on a high proportion of survivors. To inform this debate, the “best data” for analysis are reviewed based on a number of criteria of quality for survival and outcome studies. Based on these data sets, >25% of babies born alive at 24 wk and below survive without major disability.

Conclusion: An objective review of “best data” will provide the basis of an informed debate on whether providing intensive care for all very immature babies is appropriate in developed countries.
Protective effects of breastfeeding against urinary tract infection
Authors: Hanson LÅ
Published: August 2010

Protective factors in human milk act on mucosal membranes in the upper and lower respiratory tract and in the gastrointestinal tract. The way in which breastfeeding may reduce the risk of infections in a more remote site such as the urinary tract will be elucidated.

Conclusion: The protective effect of breastfeeding on the urinary tract illustrates the complexity of the immune defence mechanisms responsible for such an action.
Sexual knowledge and behaviour in South African students: a case for prevention with focus on behaviour
Authors: Lagerberg D
Published: August 2010

A study by James et al. revealed discrepancies between students' knowledge of sexuality and their behaviour.

Conclusion. Preventive programmes should be intensive, comprehensive and preferably school based, involving parents and local communities. To make themselves trustworthy, it may be worthwhile for programmes to acknowledge adolescents' life situation as it is.
Major malformations in infants exposed to antiepileptic drugs in utero, with emphasis on carbamazepine and valproic acid: a nation‐wide, population‐based register study
Authors: Wide K , Winbladh B , Källén B
Published: August 2010

Aim: Antiepileptic drugs (AEDs) are known teratogens. Some specificity between different AEDs has been noted in the literature. The aim was to compare the teratogenic effect of valproic acid (VPA) and carbamazepine (CBZ) in monotherapy. Methods: Infants exposed to AEDs (n= 1398) in early pregnancy were identified from the Swedish Medical Birth Registry. The number of infants with congenital malformations and exposed to AED was compared with the expected number estimated from all infants born (n= 582656). Results: 90% (1256) of the AED exposed children were exposed to AEDs in monotherapy, 56% were exposed to CBZ and 21% to VPA. The odds ratio (OR) for having a malformation in the AED exposed group was 1.86 [95% confidence interval (95% CI) 1.42‐2.44]. Exposure to VPA in monotherapy compared with CBZ in monotherapy gave OR = 2.51 (95% CI 1.43‐4.68) for a neonatal diagnosis of malformations. However, there is no information available on the number of therapeutic abortions, or the different types of epilepsy or drug dosage in the two treatment groups.

Conclusion: There was a small increase in the risk of having a major malformation after exposure to AEDs in monotherapy. Exposure to VPA seems to carry a higher risk than exposure to CBZ.
Early nasal continuous positive airway pressure in a cohort of the smallest infants in Denmark: neurodevelopmental outcome at five years of age
Authors: Hansen BM , Hoff B , Greisen G , Mortensen EL ,   for the Danish ETFOL study group
Published: August 2010

Aim: To evaluate neurodevelopmental outcome at age 5 y of age in a cohort of preterm children treated mainly with nasal continuous positive airway pressure (CPAP) in the neonatal period. Methods: A national prospective observational study was conducted in Denmark which included all 269 surviving children with a birthweight below 1000 g or a gestational age below 28 wk born in Denmark in between 1994 and 1995. A total of 164 children (61%) had been treated with nasal CPAP only in the neonatal period. A reference group (n= 76) of term children was studied in parallel. Results: Of the 269 surviving children, 252 (94%) were examined. Twenty‐four children (10%) had cerebral palsy, and three children were blind. No case of hearing impairment was detected. Nineteen percent of the index children had an IQ score >‐2 SD and 42% had an IQ score >‐1 SD of the mean score of the reference group.

Conclusions: The intellectual development of children in this cohort treated with early nasal CPAP did not suggest a higher proportion of adverse effects on the brain compared to the published follow‐up studies of preterm children treated with mechanical ventilation. In our population‐based cohort, however, the survival rate for infants below 25 wk of gestation was relatively low and this may indicate a limit for the use of early nasal CPAP.
Lipid peroxidation assessment by malondialdehyde measurement in parenteral nutrition solutions for newborn infants: a pilot study
Authors: Picaud JC , Steghens JP , Auxenfans C , Barbieux A , Laborie S , Claris O
Published: August 2010

Aim: To determine malondialdehyde (MDA) concentrations in parenteral nutrition admixtures exposed to ambient room light, and in the serum of neonates. Methods: Using a new method to measure MDA specifically, this study analysed MDA of lipid‐containing all‐in‐one admixtures provided by the pharmacy, with a composition identical to that used in routine clinical conditions. First, 12 admixtures were exposed to ambient light for 24 h, in the neonatal intensive care unit. Secondly, 18 solutions were either exposed to (n= 9) or protected from ambient light (n= 9) during the same period. Samples of admixtures were collected at baseline and 24 h later, for MDA measurement. Serum MDA was also randomly measured in orally fed healthy neonates. Results: After 24 h exposure to ambient room light, MDA concentrations in parenteral nutrition admixtures increased from 179 (129, 348)nmol l−1rto 5800 (1632, 14679) nmol l−1 (p= 0.0002) [50th (10th, 90th) centiles]. When admixtures were protected from light, the increase in MDA was significantly lower than without protection: 187 (60, 429) nmol l−1 versus 13 696 (3472, 26 049) nmol l−1 (p= 0.0003). In 54 infants with a gestational age of 33 (28, 39) wk and a birthweight of 1750 (960, 3388) g, plasma MDA concentrations were 173 (98, 315) nmol l−1.

Conclusion: In solutions protected from light, MDA concentrations were low and were close to the serum MDA concentrations observed in orally fed neonates. Administration of all‐in‐one admixtures containing lipids in ambient lighting results in intravenous infusion of high levels of MDA which may present an additional source of morbidity in immature infants. This study confirms the need to protect parenteral admixtures from light.