bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduced haemoglobin levels in infants presenting with apparent life‐threatening events–a retrospective investigation
Authors: Poets CF , Samuels MP , Wardrop CAJ , Picton‐Jones E , Southall DP
Published: January 2008

Anaemia has been shown to be associated with an increased apnoeic pause frequency and with cyanotic breath‐holding spells. In this study, the relationship between anaemia and apparent life‐threatening events was retrospectively investigated in 72 term infants referred for assessment and home monitoring following an apparent life‐threatening event. For 41 infants (25 male, 16 female; 38 Caucasian, three Asian) a venous red blood cell count was available. Their median age at the time of the apparent life‐threatening event was 2.0 (0.6‐6.7) months. The Hb levels in these 41 infants were plotted against normal data from the literature. Thirty‐four infants had Hb levels below the mean, whilst six infants had values above the corresponding normal mean; the one remaining infant had a Hb value identical to the normal mean. Significantly more infants than expected had Hb levels below the mean (p < 0.001, binomial test). Anaemia may have played a role in the pathophysiology leading to life‐threatening events in some of the infants investigated in this study.
Clinical value of measuring the interferon‐induced enzyme 2'‐5'‐oligoadenylate synthetase in children
Authors: Huppertz Hans‐Iko , Becker Klaus , Kreth Hans W
Published: January 2008

2'‐5'‐oligoadenylate synthetase, an interferon‐induced enzyme and a sensitive indicator of the presence of interferon, was measured in peripheral blood mononuclear cells in children with inflammatory disorders of known and unknown origin in order to assess the value of such a test in patient management. Differences in median 2'‐5'‐oligoadenylate synthetase values in groups of children with viral or bacterial diseases or healthy children were observed. Considerable overlap of the 2'‐5'‐oligoadenylate synthetase range in the three groups was observed. All children with acute viral infections had increased levels early in their disease and a low value clearly argued against an acute viral infection. However, as more than one‐third of children with bacterial diseases displayed elevated 2'‐5'‐oligoadenylate synthetase concentrations, distinction between a viral and bacterial cause of disease by measuring this enzyme was difficult. Estimation of 2'‐5'‐oligoadenylate synthetase concentrations in patients with inflammatory diseases of unknown origin, including juvenile rheumatoid arthritis, systemic lupus erythematosus, idiopathic uveitis and glomerulonephritis did not contribute to establishing a diagnosis or measuring disease activity.
Changes in cerebral oxygenation and cerebral blood volume during endotracheal suctioning in ventilated neonates
Authors: Skov L , Ryding J , Pryds O , Greisen G
Published: January 2008

The effect of endotracheal suctioning on cerebral haemodynamics was investigated in 29 newborn infants with a mean gestational age of 31 weeks (range 25‐40 weeks). Prior to one of two suctioning procedures, the inspiratory fraction of oxygen was increased by 10%. Brain oxygenation and total haemoglobin concentration were estimated continuously by near infrared spectroscopy. Mean arterial blood pressure, arterial blood oxygen saturation and carbon dioxide tension were recorded simultaneously. Brain oxygenation decreased in parallel with arterial oxygen saturation during suctioning. Preoxygenation ameliorated the decrease in brain oxygenation and arterial oxygen saturation whereas there was no benefit with regard to the changes in total haemoglobin concentration, carbon dioxide tension or mean arterial pressure. Changes in total haemoglobin concentration were related closely to concomitant changes in carbon dioxide tension (p < 0.0001) but unrelated to changes in mean arterial pressure or arterial oxygen saturation. Our findings suggest that cerebral blood volume may react to changes in carbon dioxide tension during endotracheal suctioning in mechanically ventilated neonates. Apparently, preoxygenation prior to suctioning does not ameliorate the stress in normoxic infants.
Low incidence rates by birth of symptomatic coeliac disease in a Danish population of children
Authors: Weile Birgitte , Krasilnikoff Peter A
Published: January 2008

Using the original diagnostic criteria of the European Society for Paediatric Gastroenterology and Nutrition for symptomatic coeliac disease in children, we found an average incidence rate by birth of 0.10 per 1000 live births in a demographically homogeneous Danish population over a 15‐year period. This incidence rate by birth is the lowest described in an epidemiological study in contrast with rates of 0.33 to 8 per 1000 live births found in other western countries. This difference may be explained by the different diagnostic criteria used for coeliac disease. Another contributing factor may be a late and gradual introduction of gluten‐containing cereals into the diet of Danish infants.
Normokalaemic pseudohypoaldosteronism is present in children with acute pyelonephritis
Authors: Rodriguez‐Soriano J , Vallo A , Quintela MaJ , Oliveros R , Ubetagoyena M
Published: January 2008

The present study demonstrates that renal tubular unresponsiveness to aldosterone, without associated hyperkalaemia, is present in children with acute pyelonephritis. We studied 32 children with a diagnosis of acute pyelonephritis established by high fever, flank pain/tenderness, increased blood levels of C‐reactive protein and significant Escherichia coli growth in the urine culture. Renal tubular function tests and determinations of plasma renin activity and aldosterone concentration were performed at diagnosis (study 1), after three days of iv gentamycin (study 2) and after 21 days of antibiotic therapy (study 3). Findings were compared to those present in 32 normal children of similar age. Despite normal plasma potassium concentration, fractional potassium excretion and transtubular potassium concentration gradient were significantly decreased in studies 1 and 2, becoming normal in study 3. Decreased renal potassium excretion coexisted with increased values for plasma renin activity and aldosterone concentration. In study 3 these hormones remained elevated only in patients with scarred kidneys. The functional alteration present in acute pyelonephritis may be directly caused by the interstitial inflammation or be mediated by some E. coli endotoxin.
Eight‐year follow‐up of pulmonary function and oxygen uptake during exercise in 16‐year‐old males with cystic fibrosis
Authors: Stanghelle JK , Skyberg D , Haanæs OC
Published: January 2008

Eight of nine Norwegian 16‐year‐old males with cystic fibrosis, and six age‐matched, physically active controls were included in an eight‐year follow‐up study, involving pulmonary and bicycle exercise testing. The individual's level of regular physical exercise was registered, and we investigated whether or not this could be correlated to changes in clinical status, lung function and maximal oxygen uptake. Four males with cystic fibrosis trained regularly for 4‐7 h weekly, while the other four patients did no regular exercise. Three of the latter died during the study, and the fourth male in the non‐training group deteriorated significantly during the study period of eight years. The four males in the training group showed improvement in lung function parameters and maximal oxygen uptake, but two of them had more marked obstructive lung disease after the age of 24 years. Even though the sample was small, and several other factors may influence the results, the study indicates that regular physical exercise has beneficial long‐term effects on clinical status, lung function and physical fitness in adolescent cystic fibrosis males.
Increased protein absorption after acute gastroenteritis in children
Authors: Holm S , Andersson Y , Gothefors L , Lindberg T
Published: January 2008

We investigated the intestinal absorption of the macromolecule human ot‐lactalbumin during and after an episode of acute gastroenteritis in children. Twenty children were studied in the acute phase and 17 excreted rotavirus. Eleven children were studied again 5–8 weeks later (convalescent phase). Human α‐lactalbumin serum concentrations in the acute phase were similar but in the convalescent phase they were significantly (p <0.001) higher than those in the reference children. The serum concentrations were also higher in the convalescent than in the acute phase (p= 0.021). This study suggests that there is an increased absorption of proteins from the gut into the circulation 5–8 weeks after rotavirus gastroenteritis.
Increasing incidence of childhood coeliac disease in Sweden. Results of a national study
Authors: Cavell B , Stenhammar L , Ascher H , Danielsson L , Dannaeus A , Lindberg T , Lindquist B
Published: January 2008

A survey of the incidence of coeliac disease was carried out by asking all 43 paediatric departments in Sweden to report the number of children born between 1978 and 1987 in whom coeliac disease had been diagnosed. Thirty‐four departments representing a population of 7.18 million reported 1944 cases of coeliac disease among 804935 children born between 1978 and 1987. The cumulative incidence of coeliac disease was 1.7 per 1000 live births in children born between 1978 and 1982 and doubled to 3.5 per 1000 live births in children born after 1982. The highest incidence was found in the southern and south‐eastern regions of the country. The observed increase may have been influenced by changes in infant feeding practices such as the postponed age of introduction of gluten from four to six months of age and an increase in gluten content of proprietary baby foods.
Hormonal treatment of cryptorchidism—hCG or GnRH—a multicentre study
Authors: Christiansen P , Müller J , Buhl S , Hansen OR , Hobolth N , Jacobsen BB , Jørgensen PH , Kastrup KW , Nielsen K , Nielsen LB , Pedersen‐Bjergaard L , Petersen KE , Petersen SA , Thamdrup E , Thisted E , Tranebjærg L , Skakkebæk NE
Published: January 2008

In a modified, double‐blind controlled study, 163 prepubertal boys (aged 1.8–13.0 years) with bilateral and 94 (aged 1.5–13.1 years) with unilateral cryptorchidism were allocated to treatment with either human chorionic gonadotropin (im), gonadotrophin releasing hormone (intranasally) or placebo (intranasally). In individuals with the bilateral condition treatment with human chorionic gonadotrophin resulted in complete descent of both testes in 23% of patients. Treatment with human chorionic gonadotrophin in unilateral cryptorchidism resulted in complete descent in 19% of patients; all results were significantly better than those obtained with gonadotrophin releasing hormone or placebo. Linear and logistic regression analysis of the results obtained by treatment of bilateral disease showed that all treatments were more successful the younger the age of the boys. The data indicated that bilateral and unilateral cryptorchidism respond differently to hormonal treatment. We suggest that human chorionic gonadotrophin should be the first choice of treatment for prepubertal boys older than one year.
Exogenous porcine surfactant (Curosurf) is inactivated by monoclonal antibody to the surfactant‐associated hydrophobic protein SP‐B
Authors: Kobayashi Tsutomu , Robertson Bengt , Grossmann Gertie , Nitta Keiko , Curstedt Tore , Suzuki Yasuhiro
Published: January 2008

A monoclonal antibody to the surfactant‐associated hydrophobic protein SP‐B was added at various concentrations to a standard preparation of porcine surfactant (Curosurf 10 mg/ml), and surface properties were evaluated with pulsating bubble. Retarded adsorption of surfactant was observed at antibody concentrations 0.5 mg/ml and significantly increased values for minimum surface tension were observed at antibody concentrations 1 mg/ml. In vivo effects of the antibody were tested in immature newborn rabbits ventilated with a standardized sequence of insufflation pressures. Animals receiving 0.1 ml surfactant (80 mg/ml) mixed with antibody at concentrations 4 mg/ml had low tidal volumes, poor lung stability in pressure‐volume recordings, poor alveolar expansion in histological sections and widespread epithelial necrosis in peripheral airways. Admixtures of IgG had no such effects. We conclude that this monoclonal antibody inactivates exogenous porcine surfactant, probably by preventing fast adsorption of surfactant lipids to the alveolar air‐liquid interfaces.
Growth and nutrition in 10 girls with Rett syndrome
Authors: Thommessen M , Kase BF , Heiberg A
Published: January 2008

Cross‐sectional and retrospective data on growth and anthropometric outcome, feeding problems and dietary intake are presented for 10 girls between three and 16 years of age with Rett syndrome. All girls had birth weight and length within the normal range for gestational age and development was considered normal until six to 24 months of age. The girls presented a fall off in linear growth during the first two years of life and at the time of study, all but one had height and/or weight for height below the 2.5th percentile of healthy children. The girls had good appetite but could not eat by themselves and oral‐motor dysfunctions were common. The mean energy intake was 66.9% of the US recommendations according to age and 107.8% of the recommendations according to body weight. The intakes of thiamin, vitamin D, calcium and iron were considered low. None was anaemic. Different nutritional intervention strategies should be investigated to reduce and, if possible, prevent malnutrition and wasting in girls with Rett syndrome.
Management of extremely low‐birth‐weight infants
Authors: Coccia Carlo , Pezzani Marco , Moro Guido E , Minoli Iolanda
Published: January 2008

Better health care of women during pregnancy and delivery, improvement in neonatal intensive therapy and technology have led to a decrease in neonatal mortality and morbidity and to lower limits of birth weight and gestational age for survival. This paper refers to the management protocol used in the Department of Perinatal Pathology of the Provincial Maternity Hospital of Milan for extremely low‐birth‐weight (ELBW) infants (birth weight < 1000 g). In this hospital, all newborn infants presenting evidence of life, irrespective of birth weight and gestational age, are resuscitated and transferred to the Neonatal Intensive Care Unit (NICU) for clinical management. After the introduction of this protocol the mortality rate of ELBW infants dropped from 71.4% in 1977–78 to 48% in 1987–88. In a group of 72 ELBW infants with a mean birth weight of 850 g and a mean gestational age of 27 weeks, 80% presented a normal outcome, 12% presented a mild neurological impairment and 8% were affected by severe cerebral palsy at the age of two years. The intact survival of a newborn infant of 450 g at birth is also reported.
Intact survival of a 280‐g infant: an extreme case of growth retardation with normal cognitive development at two years of age
Authors: Muraskas Jonathan K , Myers Thomas F , Lambert George H , Anderson Craig L
Published: January 2008

The care of infants born weighing less then 500 g is not only controversial but is also associated with medical uncertainties. We report the management of a growth retarded infant who weighed 280 g at birth after 26.9 weeks’gestation. The child not only survived but appears developmentally normal at two years of age. Although the infant is the smallest survivor reported, the case demonstrates the importance of gestational assessment in deciding delivery room management.
Epidemiological and clinical characteristics of acute and persistent diarrhoea in rural Bangladeshi children
Authors: Baqui Abdullah H , Black Robert E , Sack R Bradley , Yunus MD , Siddique AK , Chowdhury HR
Published: January 2008

A community‐based longitudinal study of acute and persistent diarrhoea in 705 children less than five years old was carried out for a year in a rural area of Bangladesh. Diarrhoea morbidity data were collected from each study child every fourth day by home visit. Clinical features of diarrhoeal episodes and diarrhoeal management information were documented. The overall diarrhoeal incidence rate in the study children was 4.6 episodes per child per year. The incidence of persistent diarrhoea was 34/100 child‐years. Persistent diarrhoea was positively associated with young age and more severe illness, characterized by the presence of clinical dehydration or blood in the stool in the first week. Use of ORT in the first week was positively associated and use of an antibiotic was negatively associated with the occurrence of persistent diarrhoea. Reduced breast‐feeding and consumption of cow's milk at some time during the episode were also positively associated with persistence. This would suggest that appropriate fluid and dietary management for all episodes should be the goal. Children with more severe initial illness characterized by the presence of blood in the stool or clinical dehydration should have more careful follow‐up to identify persistent episodes and adverse nutritional effects. Breastfeeding should be continued during acute diarrhoea, but the role of ORT, antibiotics and cow's milk deserves further investigation.
Oral gentamicin is not effective treatment for persistent diarrhea
Authors: Bartlett Alfred V , Torun Benjamin , Morales Carlos , Cano Floridalma , Cruz Jose Ramiro
Published: January 2008

We conducted a randomized, double‐blind, placebo controlled clinical trial of oral gentamicin (10 milligrams/kilogram body weight/day for five days) in treatment of unselected cases of persistent diarrhea (duration 14‐18 days at initiation of treatment) among 3‐36‐month‐old children in a rural Guatemalan community. Following random assignment of each child to a treatment group, the appropriate dose of gentamicin or placebo was administered to the child three times daily by a study nurse; this nurse also identified the presence or absence of diarrhea on each day of treatment and for the next two days. Cure was defined as cessation of diarrhea during the five‐day treatment period, sustained through at least the two days after completion of treatment. Among 92 evaluable cases who entered the clinical trial, there was essentially no difference in cure rate between gentamicin and placebo treatment groups (42% versus 43%). Enteroadherent strains of Escherichia coli were identified in 46% of children tested in this trial; no significant difference existed between treatment groups in frequency of isolation of this or any other enteropathogen. Among 40 children having successful duodenal cultures immediately prior to beginning treatment, 104 aerobic organisms per milliliter of fluid were identified in 12 (30%); treatment groups did not differ substantially with respect to proportion of children identified with this level of duodenal microbial colonization. Failure of gentamicin treatment did not appear to be explained by emergence of resistance, although a small number of resistant enteropathogens were identified near the end of the study. We conclude that in this population and in the dose used, oral gentamicin has no value in the treatment of persistent diarrhea.
Effect of melanin, oxyhemoglobin and bilirubin on transcutaneous bilirubinometry
Authors: Onks D , Silverman L , Robertson A
Published: January 2008

To determine the effect of skin pigments on transcutaneous bilirubinometer readings, we measured the effect of bilirubin, melanin, and oxyhemoglobin solutions on transcutaneous bilirubinometer readings in vitro. Our results showed that the variability of the readings in vitro was related to the instrument's non‐linear response to bilirubin and melanin concentration and an inacurate oxyhemoglobin correction factor. These factors should be considered in developing a more accurate non‐invasive method of monitoring serum bilirubin concentration.
The risk of bilirubin encephalopathy, as estimated by plasma parameters, in neonates strongly suspected of having sepsis
Authors: Ebbesen F , Knudsen Aa
Published: January 2008

The study comprises 18 mature newborns, strongly suspected of having sepsis, and a control group of 18 mature, healthy newborns with the same postnatal age. The object of the investigation was to compare the risk of development of bilirubin encephalopathy between the two groups, as estimated by plasma parameters. The sepsis group had significantly lower reserve albumin concentration for binding of MADDS (p<0.01) and significantly lower total albumin concentration (p<0.01). No significant differences were observed in unconjugated bilirubin concentration and plasma pH. It is suggested that mature newborns with sepsis have a slightly increased risk of developing bilirubin encephalopathy.
Empiric red cell transfusion in asymptomatic preterm infants
Authors: Meyer J , Sive A , Jacobs P
Published: January 2008

In a prospective randomized trial, asymptomatic very low‐birth‐weight infants in a neonatal intensive care unit were either electively transfused with red cells to maintain capillary haematocrit greater than 0.35 l/l (group 1; n= 9), or were not transfused (group2; n= 10). Individuals from both groups were excluded if they subsequently received non‐elective transfusions, necessitated by their clinical condition. Electively transfused infants gained weight more rapidly than their non‐transfused counterparts, but the duration of hospitalization was not shortened. Criteria of morbidity, such as patent ductus murmurs, apnoea and failure to thrive, were similar in both groups. We conclude that in the absence of clinical indications, transfusion to achieve a haematocrit greater than 0.35 l/l as an empiric procedure, improves weight gain but the risks of transfusion are likely to outweigh the benefits.
Extremely low‐birth‐weight infants less than 901 g. Growth and development after one year of life
Authors: Stjernqvist K , Svenningsen NW
Published: January 2008

In a long‐term prospective control study, 20 extremely low‐birth‐weight infants with birth weights between 500 and 900 g (mean 755±109 g) and gestational ages between 24 and 30 weeks (mean 26.2±1.8 weeks) were compared with 20 full‐term infants, after the first year of life for growth, development and continuing morbidity after discharge from the intensive care unit. The total rate of neurological abnormalities was 17%; the rate of infantile post‐haemmorrhagic hydrocephalus requiring shunt operations was 8.7%, while 13% had retinopathy of prematurity with vision deficit, but none was blind. The hospital readmission rate was 70%, but for most infants only one or a few readmissions were needed whereas three infants with chronic lung disorders required frequent hospital readmissions, mainly for respiratory infections. Apart from 4 infants with major cerebral neonatal complications, 16 of 20 extremely low‐birth‐weight infants (80%) showed development within the normal range at one year of age, although with delay in some areas in comparison with full‐term control infants. Follow‐up into preschool and school age is in progress. We cautiously suggest that the results at the one year follow‐up do indicate a possible favourable long‐term outcome for many of these extremely low‐birth‐weight infants with normal cognitive development and with no major neurological sequelae.
Oral versus intravenous premedication for small bowel biopsy in children: effect on procedure and fluoroscopy times
Authors: Stenhammar L , Wärngård O , Lewander P , Nordvall M
Published: January 2008

Oral alimemazine and cisapride, or diazepam and cisapride, or iv midazolam and metoclopramide were given as premedication for small bowel biopsy to three groups of children from a total population of 185 individuals. The biopsy procedures were performed under intermittent fluoroscopy and times for both were recorded. The median biopsy procedure time was significantly shorter in children given iv midazolam and metoclopramide (6 min) compared to those given oral premedication (10 min) (p < 0.001). The median fluoroscopy time was very short in all groups, ranging between 3 and 6 s. It is concluded that iv premedication is superior to oral premedication for small bowel biopsy in children because more effective sedation is obtained.
Seizures as the presenting symptom of brain tumors in children
Authors: Sjörs Kerstin , Blennow Gösta , Lantz Göran
Published: January 2008

Epileptic seizures caused by tumors in children have been regarded as uncommon. We have studied 99 consecutive cases of brain tumors during the period 1980–1987. In 20 cases the tumor was localized to one of the hemipheres and 10 of the cases had seizures, in 9 as the only initial symptom. Details of the clinical picture and the course are presented. Delay from initial symptoms to correct diagnosis was considerable in 4 cases—more than six years. The factors mainly responsible for this delay were: initial EEG normal or soon normalized, misinterpretation of computerized tomography and seizure freedom with or without antiepileptic drug treatment. We conclude that regional slowing in the EEG is a common, although not obligatory, finding. Computerized tomography should be performed in all children with newly presented epilepsy of partial type, except for those with benign partial epilepsy with centro‐temporal spikes.
Mental health and psychosocial functioning in adolescents with congenital heart disease. A comparison between adolescents born with severe heart defect and atrial septal defect
Authors: Spurkland I , Bjørnstad PG , Lindberg H , Seem E
Published: January 2008

Twenty‐six adolescents, aged 13–18 years, with severe congenital heart disease were matched for sex, age and living area with 26 adolescents with repaired atrial septal defect and regarded as physically fit. These two groups were compared according to somatic condition, psychopathology, psychosocial functioning and chronic family difficulties. A higher rate of psychiatric problems in the complex group, an association between psychosocial functioning and physical capacity, as well as an association between psychosocial functioning and chronic family difficulties were observed. These findings suggest that physical capacity is of crucial importance for mental health and functioning of adolescents with congenital heart disease. The association with chronic family difficulties also suggests that a comprehensive biopsychosocial approach is necessary in the treatment and rehabilitation of these patients.
Evaluation of attempted prevention of unexpected infant death in very high‐risk infants by planned health care
Authors: Taylor EM , Spencer NJ , Carpenter RG
Published: January 2008

Three hundred and ninety‐six babies born in Sheffield between 1982 and 1990 identified as being at “very high risk” of unexpected infant death by means of a scoring system, received an intensive programme of health care including a case discussion between a paediatrician, the GP and the health visitor held in the family doctor's surgery, weekly visits from the health visitor and informal hospital admission. Significantly fewer sudden unexpected infant deaths occurred in this group than were expected by logistic regression anlysis or occurred in the best available control group with comparable scores (p = 0.024). Problems in evaluation include identification of an adequate control population, ethical difficulties in introducing a controlled study when the programme is already perceived as effective, and the calculation of “expected death rates”. The results of this study indicate that very energetic programmes of intervention may prevent some deaths in vulnerable infants.
Pericardial effusion complicating a percutaneous central venous line in a neonate
Authors: Beattie PG , Kuschel CA , Harding JE
Published: January 2008

A premature infant developed pericardial effusion four days after the insertion of a 25‐gauge silastic percutaneous central venous catheter. The effusion contained parenteral nutrition fluid and resolved rapidly after withdrawal of the catheter. Pericardial effusion is a potential complication of percutaneous, as well as surgically placed, central venous catheters.
Personality and behaviour in eight‐year‐old, non‐handicapped children with birth weight under 1500 g
Authors: Sommerfelt K , Ellertsen B , Markestad T
Published: January 2008

Personality and behavioural characteristics of a population‐based cohort of 29 very low‐birth‐weight (VLBW) infants were compared with those of 29 matched, term controls at eight years of age. The VLBW infants were born to families of lower socioeconomic status (p = 0.04) and had a lower mean IQ (93 versus 104, p = 0.008) and motor abilities (p = 0.028). Based on the questionnaire personality inventory for children, the VLBW children had more learning difficulties and school coping problems, and the VLBW boys had more conduct and emotional problems than the controls. Except for conduct problems, these differences persisted after controlling for socioeconomic status. Generally, there were significant relationships between behaviour, IQ and motor abilities. In conclusion, VLBW may be a risk factor for the development of school coping and behavioural problems independent of socioeconomic status but often coexist with impaired cognitive and neuromotor function.
Variation in serum C‐reactive protein across the clinical spectrum of meningococcal disease
Authors: Marzouk O , Bestwick K , Thomson APJ , Sills JA , Hart CA
Published: January 2008

In a multicentre prospective study, 124 cases of meningococcal disease were classified into the clinical categories, meningitis alone (n = 15), meningitis and septicaemia (n= 79) and septicaemia alone (n = 30). A further 60 children referred with other illnesses served as controls. Serial measurements of serum C‐reactive protein (admission, day 1, day 2, days 5–7) were compared. Children with septicaemia had significantly lower C‐reactive protein levels on admission than those with meningitis alone or meningitis and septicaemia which were unexplained by differences in the duration of the presenting illness or severity of the disease. Within each clinical category of meningococcal disease, significant changes in C‐reactive protein concentration occurred during the course of the disease. Four control children had other types of septic meningitis: admission C‐reactive protein concentrations did not differ from those with meningitis or meningitis and septicaemia, but were significantly higher than those with septicaemia alone. The other 56 patients had a significantly lower admission C‐reactive protein concentration compared with all cases of meningococcal disease. For the diagnosis of meningococcal disease, admission C‐reactive protein levels of ≥ 40 mg/l had a sensitivity of 79%, specificity of 80% and positive predictive value of 87%. For the prognostic prediction of death in meningococcal disease (or meningococcal disease with shock) CRP < 100 mg/l on admission had a sensitivity of 69% (69%), specificity of 50% (56%) and positive predictive value of 18% (53%). In children with suspected meningococcal disease, serum C‐reactive protein, measured on admission, has diagnostic value but not prognostic value. The C‐reactive protein concentration on admission varies with the clinical category of meningococcal disease and the day of illness.
Zinc supplementation impairs monocyte function
Authors: Schlesinger Liana , Arevalo Marianela , Arredondo Sonia , Lönnerdal Bo , Stekel Abraham
Published: January 2008

Zinc has been shown to be involved in many functions of the immune system. This study was conducted to examine the effect of zinc supplementation on phagocytic, fungicidal and metabolic activity of blood monocytes of marasmic infants during nutritional rehabilitation. A controlled, double‐blind design was used in which 19 infants fed a zinc‐fortified formula were compared with 20 infants fed the same, unfortified formula. Evaluation of phagocytic‐fungicidal capacity, growth, zinc, copper and iron status was performed in both groups on admission and after 60 and 105 days of nutritional rehabilitation. Although energy, copper and iron intakes were similar in the two groups, a decrease in the number of infants able to phagocytose one or more Candida buds was observed after 60 days of zinc supplementation compared to admission (p<0.03). No change in phagocytic ability was detected between admission and 60 days in the control group. The number of infants with depressed fungicidal activity increased significantly after 105 days of nutritional rehabilitation in the zinc‐fortified group as compared to controls (p<0.04). The number and duration of impetigo episodes was significantly greater in the group fed the zinc‐fortified formula. These results suggest that zinc supplements at the RDA level may impair monocyte function.
Prevalence of coeliac disease in diabetic children and adolescents in Sweden
Authors: Sigurs N , Johansson C , Elfstrand P‐O , Viander M , Lanner Å
Published: January 2008

The aim of this study was to determine the minimum prevalence of coeliac disease in a group of 459 diabetic children and adolescents. Six patients were already known to have coeliac disease. A total of 436 patients with type 1 diabetes mellitus aged 2–21 years and with age at onset at 2 months to 17 years at three paediatric departments agreed to participate in the study. All patients were tested for gliadin IgA antibodies with a commercial kit (Pharmacia Gluten IgA EIA). Later, serum was tested for reticulin IgA/IgG antibodies. Nineteen patients had elevated gliadin IgA levels (>25 AU). Eighteen underwent jejunal biopsy. Ten had total or subtotal villous atrophy. These 10 patients were reticulin IgA‐positive. Of 417 gliadin IgA‐negative patients, 408 were reticulin IgA/IgG‐negative. Of 6 reticulin IgA‐positive patients, 3 had total or subtotal villous atrophy. All 3 had become gliadin IgA‐positive at the time of biopsy. Among 3 reticulin IgG‐positive patients with IgA deficiency, 2 had total villous atrophy: 1 was not willing to be biopsied. Patients with total or subtotal villous atrophy were judged as having coeliac disease and were recommended a gluten‐free diet. Within 2 months, gliadin IgA levels were normal in patients adhering to the diet. Five patients have gone through a second jejunal biopsy to date with normal histology in all 5. The 15 newly diagnosed patients with coeliac disease plus 6 already known patients with coeliac disease and type 1 diabetes mellitus gave a minimum prevalence of coeliac disease in diabetic children and adolescents of 21/459 = 4.6%.
A missense mutation in the hypoxanthine phosphoribosyltransferase gene in a pediatric patient with hyperuricemia
Authors: Marcus Suzanne , Sahlén Sigrid , Lambert Bo , Wettrell Göran
Published: January 2008

We have identified a mutation in the gene coding for the enzyme hypoxanthine phosphoribosyltransferase in a pediatric patient with hyperuricemia and nephrolithiasis. The mutation is a nucleotide substitution causing an amino acid substitution in the hypoxanthine phosphoribosyltransferase protein. In this patient, fibroblasts but not lymphocytes showed resistance to 6‐thioguanine, and reduced enzyme activity was detected in lymphocytes. These results are consistent with the intermediary phenotype associated with partial hypoxanthine phosphoribosyltransferase enzyme deficiency. Altogether, six males in this family suffered from hyperuricemic symptoms, and small differences in phenotype were seen.
Serum concentrations of procollagen I C‐terminal propeptide, osteocalcin and insulin‐like growth factor‐I in patients with non‐lethal osteogenesis irnperfecta
Authors: Brenner RE , Schiller B , Vetter U , Ittner J , Teller WM
Published: January 2008

Serum concentrations of procollagen I C‐terminal propeptide (PICP) were studied in 74 patients with various forms of non‐lethal osteogenesis imperfecta and 27 unaffected family members. Using the standard deviation (SD) score, PICP concentrations were found to be ≤— 1 SD in 16%, between — 1 and —2 SD in 26% and ≤— 2 SD in 58% of the patients with osteogenesis imperfecta compared to healthy controls. PICP values were lowest in osteogenesis imperfecta type I (‐ 2.4 ± 0.4 SD, n= 37) followed by type III (‐1.9 ± 0.5 SD, n = 13) and type IV (‐ 1.3 ± 0.7 SD, n= 20). Four patients with osteogenesis imperfecta with an atypical clinical course had normal or even elevated levels which may indicate heterogeneity in the underlying primary defects. In osteogenesis imperfecta type I, PICP concentrations proved to be a helpful serum marker for pedigree screening. Osteocalcin was high in 25 of 28 patients with osteogenesis imperfecta in the first decade but only in 1 of 18 older patients. Insulin‐like growth factor‐I was within the normal range in 53 cases of osteogenesis imperfecta, decreased in 2 and elevated in 3 patients. We conclude that PICP concentration is a useful parameter in the clinical management of osteogenesis imperfecta, including the assessment of future therapeutic interventions.
Alcohol intoxication in hospitalized young teenagers
Authors: Lamminpää A , Vilska J , Korri U‐M , Riihimäki V
Published: January 2008

The scientific literature concerning alcohol intoxication is enormous. However, less is known of alcohol‐induced disturbances in children and adolescents and most of those reports concern cases of hypoglycemia in children under five years of age. We studied the clinical status and chemistry, especially acid‐base balance, in 36 young teenagers treated at hospital for alcohol intoxication. On physical examination 6 patients were somnolent, 18 were comatose and 12 were in deep coma. The impairment of consciousness was directly proportional to the blood ethanol concentration. Acidosis was a central finding, and it was caused by a combination of respiratory and metabolic factors (a high blood PCO2 and a low base excess; r = 0.97, p< 0.001); the finding of respiratory acidosis dominated. Base excess correlated negatively with beta‐hydroxybutyrate and lactate, as expected. All the metabolic products measured—acetate, beta‐hydroxybutyrate and lactate—were significantly elevated compared with the control patients. No hypoglycemia was found. Prior treatment with intravenous glucose decreased vomiting and normalized the serum lactate concentration and PO2. Hypokalemia was the most common abnormality in serum electrolytes. In four patients the rate of fall of blood ethanol concentration was 2.8–3.3 mmol/h (0.13–0.15 g/l‐1 h‐1) and the mean acetate concentration was 0.8 mmol/l (SE 0.3). Biochemical disturbances in young teenage alcohol intoxicants resemble those previously found in adults. The severe toxicity by ethanol, planifesting in coma, occurs in lower blood alcohol concentrations in children than in adults
Histological findings and evidence of lipid conjugated dienes and malonyldialdehyde in human fetal aortas
Authors: D'Armiento Francesco Napolo , Gregorio Fernando Di , Ciafrè Silvia Anna , Posca Teresa , Liguori Antonio , Napoli Claudio , Colasanti Paola , Cali Antonio , Vecchione Raffaella
Published: January 2008

Recent evidence strongly suggests that peroxidative modification of lipids may play a significant role in atherogenesis. In our present research, we investigated if the oxidative stress mediated by oxygen free radicals was a pathophysiologic condition that occurred in the early stages of human development. Thus the aim of this research was to examine lipid peroxidation in human fetal aortas. Human fetal aortas and proximal iliac arteries (n= 8) were obtained from fetuses aged 7 ± 2 months, immediately after autopsy. Lipids from the initial fatty streak lesions (LFS) and the vessels uninvolved (LUV) were extracted by the chloroform/methanol method. Lipid peroxidation levels were measured by two different methods: determination of lipid conjugate dienes (the spectrum trend was recorded from 320 to 200 nm with a spectrophotometer) and malonyldialdehyde (MDA) content (TBA method). We observed that lipid conjugated dienes were present in LFS, but not in LUV, with a characteristic absorption peak at 233 nm. In addition, MDA levels were significantly higher when the LFS = 3.85 ± 0.91 nmol than when the LUV = O.41 ± 0.12 nmol (p<0.001 versus LUV). The presence of lipid peroxidation in our samples could be mediated by free radical production in the first stages of human development. Thus these data suggest that LFS peroxidation mediated by free radicals occurs in the vascular circulation in the early stages of human development. This could influence the progression of vascular damage and atherosclerotic disease.
Prevalence of potential respiratory disease bacteria in children in Ethiopia. Antimicrobial susceptibility of the pathogens and use of antibiotics among the children
Authors: Ringertz Signe , Muhe Lulu , Krantz Ingela , Hathaway Audrey , Shamebo Desta , Freij Lennart , Wall Stig , Kronvall Giiran
Published: January 2008

Acute respiratory infections are primary causes of morbidity and mortality in children in developing countries. This project was designed to investigatc antimicrobial susceptibility of respiratory tract pathogens isolated from children in rural and city areas, and to contribute to the rational choice of antibiotics for respiratory tract infections in children in Ethiopia. Nasopharynx and throat cultures were taken from all children under five years of age in three study areas representing different levels of contact with health care and accessibility to modern drugs, such as antibiotics. In all, 1126 children were cultured. Huemophilus influence and Streptococcus pneumonicie were both found in 85–90% of the children, and beta‐haemolytic streptococci group A in 12%. The level of antimicrobial resistance was low. None of the 954 strains of H. irfluence were beta‐lactamase producers. Pneumococci were susceptible to penicillin. The use of antibiotics was also low; 11 of 1126 children had antibiotics on the day of culture or the day before. The choice of antibiotics was not limited by resistance, and emphasis could be put on low cost, minimizing adverse drug reactions and ecological impact.
Very late mucosal relapse in a girl with coeliac disease
Authors: Högberg L , Stenhammar L , Wågermark J
Published: January 2008

Small bowel biopsy in a 4–year‐old girl with symptoms suggestive of coeliac disease revealed subtotal villous atrophy. The mucosa healed on a gluten‐free diet. From the age of 7 years, the girl was challenged with gluten. Annual biopsies showed normal or nearly normal mucosa specimens. At 21 years of age, after 14 years of gluten challenge, a mucosal relapse was found and a gluten‐free diet was reinstituted. A biopsy one year later showed a normal mucosa. From this case report it is apparent that a patient with a past history of subtotal villous atrophy, which after a preceding period of gluten‐free diet does not recur within two years of gluten challenge, must be followed carefully, so as not to miss a late relapse.
Cholelithiasis in cervico‐oculo‐acoustic (Wildervanck's) syndrome
Authors: Kõse Galip , Ozkan Hasan , Ozdamar Feridun , Kavukçu Salih , Ozaksoy Dinc
Published: January 2008

An unusual case of cholelithiasis in an 18–month‐old boy with cervico‐oculo‐acoustic (Wildervanck's) syndrome is presented. Our patient had Duane's retraction syndrome, Klippel‐Feil anomaly and congenital deafness. To our knowledge this is the first case in which a probable association between cholelithiasis and Wildervanck's syndrome has been recorded. On the other hand, the presence of mutual malformations and anomalies such as scoliosis, ventricular septal defect, ectopic kidney, hydrocephalus, hypoplastic thumb and growth retardation seems to suggest that Wildervanck's syndrome is a clinical variant of Klippel‐Feil sequence.
“Minitouch” treatment of very low‐birth‐weight infants
Authors: Jacobsen Thorkild , Grønvall John , Petersen Sten , Andersen† Gunnar Eg
Published: January 2008

In a cohort study with historical controls of non‐asphyxiated very low‐birth‐weight infants (birth weight ≤ 1500 g and gestational age <33 completed weeks), we evaluated the use of a “minitouch” regime for stabilization after birth and treatment of respiratory distress. This combination of early (prophylactic) treatment with nasal continuous positive airway pressure and minimal handling was introduced as a routine in our Department in 1986. We compared infants born in 1987 and in 1985, when ventilator treatment was used initially in all infants with progressing respiratory distress. The frequency of mechanical ventilation was reduced significantly from 76% in 1985 to 35% in 1987 (p = 0.00001). This reduction reflected the smaller number of infants who received ventilator treatment for less than one week, whereas the frequency of long‐term ventilator treatment remained unchanged. Intracranial haemorrhage grade 11‐IV was reduced from 49% in 1985 to 25%) in 1987 (p = 0.01). Mortality rate, average duration of hospitalization, numbcr of infants with pneumothorax, patent ductus arteriosus, need for oxygen at 28 days and number of surviving infants with handicap did not differ significantly between the two study periods. Septicaemia was diagnosed in 16%) of the infants in 1987 versus 7% in 1985 (p = 0.045). This difference coincided with an increased use of total parented nutrition (18% in 1987 versus 3%) in 1985, p= 0.007). We conclude that the minitouch regime prevents progression of respiratory distrcss, reduces the need for ventilator treatment and is a safe and convenient alternative to mechanical ventilation in preterm infants with mild respiratory problems. The infants need to be monitored continuously to recognize respiratory insufficiency demanding ventilator treatment.
Surfactant inhibition in experimental meconium aspiration
Authors: Sun Bo , Curstedt Tore , Robertson Bengt
Published: January 2008

Human meconium components were separated into a water‐methanol soluble phase containing mainly proteins and bilirubin and a chloroform soluble phase containing free fatty acids, triglycerides and cholesterol. Various amounts of original meconium, the water‐methanol soluble fraction or the chloroform soluble fraction were added to standard suspensions of porcine surfactant (Curosurf). In a pulsating‐bubble or Wilhelmy‐balance system, meconium and its subfractions inhibited surfactant activity, but the chloroform soluble fraction had the highest specific inhibitory activity. Original meconium in saline (130 or 65 mg/ml) was instilled into the airways of ventilated near‐term newborn rabbits (dose 6 ml/kg). Lung‐thorax compliance was reduced by 38% in animals aspirating the higher dose and by 27% in the low‐dose group. Histological sections showed intra‐alveolar accumulation of fine meconium particles in experimental animals, but no plugging of larger airways. We conclude that respiratory failure from meconium aspiration may be mediated, in part, by inactivation of surfactant.
Chronic lung disease of preterm infants in Finland is not associated with Ureaplasma Ureaplasma colonization
Authors: Saxén H , Hakkarainen K , Pohjavuori M , Miettinen A
Published: January 2008

The occurrence of Ureaplasma Ureaplasma and Mycoplasma hominis in the airways and the association of these microorganisms with chronic lung disease was studied in preterm infants with a gestational age less than 30 weeks. Tracheal aspirates from 49 preterm infants were cultured; 14 (29%) infants were positive for U. Ureaplasma, and 1 (2%) was positive for M. hominis. Of the 16 patients who developed lung disease, 6 (38%) were positive for U. Ureaplasma, while the expected number of Ureaplasma‐positive patients in this group, based on the overall incidence of Ureaplasma, was 4.6. On the other hand, 8 patients were positive for U. Ureaplasma but did not develop chronic lung disease, nor did samples taken from 10 patients with chronic lung disease show any Ureaplasma growth. From these data we conclude that colonization of the airways with U. Ureaplasma has no significant role in the development of chronic lung disease in preterm infants in the Finnish (Caucasian) population.