bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnesium and Zinc in Diabetic Pregnancy
Authors: WIBELL L. , GEBRE‐MEDHIN M. , LINDMARK G.
Published: January 2008

ABSTRACT. The concentrations of zinc and magnesium in serum were investigated in 23 non‐pregnant and 14 pregnant women with insulin‐dependent diabetes (IDDM) and 20 with gestational diabetes, and in cord blood from newborns of the latter two groups. These groups were compared with healthy women, non‐pregnant as well as parturient, and newborns of the latter. In the non‐pregnant state the mean serum concentrations of zinc and magnesium were lower in IDDM patients than in healthy control women. Although a decrease in S‐Zn and S‐Mg was obsenwl during pregnancy in both IDDM and control subjects, the difference between carefully insulin‐treated IDDM patients and controls was no longer apparent at term of pregnancy as regards S‐Zn, whereas S‐Mg was lower at term both in IDDM patients and in insulin‐treated women with gestational diabetes. Besides the probable importance of a nearly normalized glucose metabolism in IDDM patients during pregnancy, it is postulated that the altered pattern of plasma proteins in diabetes and pregnancy, and possibly also exogenous insulin may influence the serum concentrations of zinc and magnesium seen at the end of pregnancy.
Children of Alcoholic Mothers: Developmental, Perceptual and Behavioural Characteristics as Compared to Matched Controls
Authors: ARONSON M. , KYLLERMAN M. , SABEL K.‐G. , SANDIN B. , OLEGÅRD R.
Published: January 2008

ABSTRACT. From a retrospective material including all the 103 children of 30 alcoholic women, the 21 youngest born 1970‐76, were paired to controls matched for sex, age, birth weight, gestational age and living area. IQ scores were measured with Griffiths and WISC scales. Controls tested within the normal range for Swedish children, while the study group scored 15‐19 IQ points below controls (p<0.01), the means of the study group corresponding to ‐1.6 SD below means of the controls. Significant differences between the groups were found in all subscales. Visual perception was measured with Frostig's test. Perceptual age was generally equal to mental age except in the most severely affected cases where perceptional age was lower than mental age. A marked perceptual delay exceeding 1 year was found in 8/17 tested cases in the study group, while all controls were normal. Developmental levels evaluated from Human Figure Drawings according to Koppitz was in accordance with IQ testresults. Indicators of emotional instability were found significantly more often in the study group than in controls. Hyperactivity, distractability and short attention span were found in 12/21 cases and perseveration in 6/21 cases but not among controls. Members of the study group with traits of the fetal alcohol syndrome (10/21) had significantly lower IQ and perceptual delay was more pronouned than in members without such signs. No significant IQ difference was found between subjects reared in foster homes and in biological homes.
Susceptibility of Riboflavin and Vitamin A in Breast Milk to Photodegradation and Its Implications for the Use of Banked Breast Milk in Infant Feeding
Authors: BATES C. J. , LIU D.‐S. , FULLER N. J. , LUCAS A.
Published: January 2008

ABSTRACT. Up to 50 % of the riboflavin and up to 70 % of the vitamin A in human drip breast milk samples were destroyed during controlled exposure to daylight, either in translucent polythene bottles, or where the milk was pumped through naso‐gastric tubing from a syringe to mimic the conditions of enteral feeding. Losses were also observed in milk which was exposed to standard phototherapy illumination under conditions similar to those encountered in the ward, and in this case riboflavin was destroyed to a greater extent than vitamin A. Photodegradation of riboflavin may contribute to the high incidence of biochemical riboflavin deficiency reported in preterm infants receiving breast milk without vitamin supplements. The implications of these findings for feeding high risk term and preterm infants on donor milk are discussed, and the use of low actinic vessels and tubing to minimise photodegradation is recommended.
Urinary Tract Infection in Children with Type I Diabetes
Authors: LINDBERG U. , BERGSTRÖM A. L. , CARLSSON E. , DAHLQUIST G. , HERMANSSON G. , LARSSON Y. , NILSSON K. O. , SAMUELSSON G. , SJÖBLAD S. , THALME B.
Published: January 2008

ABSTRACT. The prevalence and incidence of bacteriuria in 304 girls and 337 boys with type I diabetes was studied by screening for bacteriuria at their regular outpatient controls. In 90 girls and 108 boys a urine specimen was sampled every third month during a year. The prevalence of bacteriuria was 3/304 in girls and 0/337 in boys. During the one year follow‐up one of the 90 girls had pyelonephritis and two cystitis while none of the boys had bacteriuria. It is concluded that the rate of urinary tract infection in young diabetic persons does not differ from that present in healthy young people.
Ribonuclease in Different Types of Saliva from Cystic Fibrosis Patients
Authors: CEDER O. , DIJKEN J. VAN , ERICSON T. , KOLLBERG H.
Published: January 2008

ABSTRACT. The flow rate, the activity of ribonuclease (RNAase) and the concentration of protein were determined in whole saliva and in parotid and submandibular saliva from patients with cystic fibrosis (CF) and from healthy controls, both before and after stimulation of the salivary secretion. Lower flow rates were found in all types of saliva from CF‐patients than in control saliva. Increased activity of RNAase was found in CF saliva, both before and after stimulation of the secretion. The concentration of protein was also increased, but to a lesser degree. No correlation was found between either RNAase activity or protein concentration and severity of the disease or age of the children. It is therefore unlikely that these disturbances are secondary to progression of the disease. Considerable variations in RNAase activity and protein concentration were observed, especially within the CF group, and therefore despite the significant increase in these variables in CF their estimation is of limited diagnostic value.
Fatal Case of Pyruvate Dehydrogenase Deficiency
Authors: MATSUO M. , OOKITA K. , TAKEMINE H. , KOIKE K. , KOIKE M.
Published: January 2008

ABSTRACT. A Japanese neonate with fatal pyruvate dehydrogenase deficiency is described. The patient lapsed into a coma shortly after birth with severe metabolic acidosis caused by accumulation of lactate and pyruvate. Hyperammonemia was also present and found to be the cause of the coma. Despite intensive treatment, the patient died at 93 hours of age. Enzyme study showed that the activity of pyruvate dehydrogenase was not detected in either the liver or the kidneys. This is the third reported case of fatal pyruvate dehydrogenase deficiency and hyperammonemia is described for the first time in this condition.
Mechanical Feeding Difficulties after Primary Repair of Oesophageal Atresia
Authors: SMITH IAIN J. , BECK JOHN
Published: January 2008

ABSTRACT. A detailed feeding questionnaire was sent to 35 sets of parents of children who had undergone successful primary repair of oesophageal atresia. Twenty‐three were returned completed. All indicated difficulty with feeding. Some foods were better tolerated than others. Eighteen children had episodes of food sticking in the oesophagus, the parents using a variety of techniques to remove this. We feel that it may be possible to offer constructive, practical advice on feeding these children.
Influence of the Maternal Plasma Glucose Concentration at Delivery on the Risk of Hypoglycaemia in Infants of Insulin‐Dependent Diabetic Mothers
Authors: ANDERSEN O. , HERTEL J. , SCHMØLKER L. , KÜHL C.
Published: January 2008

Plasma glucose concentrations at birth and at two hours of age were measured in 53 infants of insulin‐dependent mothers (IDMs). The plasma glucose concentrations at delivery were measured in the mothers of 17 IDMs and in the remaining 36 mothers, glucose was estimated by interpolation from concentrations achieved just before and after delivery. Clinical and laboratory data from the two groups were otherwise similar, so the groups were combined for further analyses. The maternal plasma glucose at delivery correlated positively with the glucose concentration of the IDMs at birth (Q=0.82, p<0.001) and negatively with the glucose concentration at two hours of age (Q= ‐0.46, p<0.001). Maternal plasma glucose concentration was higher in mothers delivered by caesarean section than in vaginally delivered mothers (p<0.05). Eleven IDMs became hypoglycaemic at two hours of life (plasma glucose ≥1.7 mmol/1). These infants had higher cord plasma glucose concentrations at birth than those who remained normoglycaemic; the maternal glucose concentration was also higher. None of the IDMs became hypoglycaemic if the maternal glucose concentration at delivery was less than 7.1 mmol/l. In 28 IDMs the simultaneous plasma concentrations of non‐antibodybound immunoreactive insulin (IRI) were recorded. Cord plasma IRI correlated with glucose and IRI at two hours of age (Q=‐0.73, p<0.001 and Q=0.77, p<0.001, respectively). Cord plasma IRI was higher in IDMs who became hypoglycaemic than in the remaining infants. The results suggest that among the factors which may be responsible for neonatal hypoglycaemia in IDMs a major factor may be the maternal plasma glucose concentration at the time of delivery.
Peripheral Facial Palsy in Children: A Cerebrospinal Fluid Study
Authors: SANDSTEDT P. , HYDEN D. , ODKVIST L. M. , KOSTULAS V.
Published: January 2008

Seven children and five adults with acute, peripheral facial palsy were investigated by clinical, blood and cerebrospinal fluid (CSF) examinations. Routine blood examinations and blood and CSF serological tests were normal. In all children studied the CSF showed an increased number of mononuclear white cells despite the absence of clinical signs of meningitis in all but one. Two of the twelve patients studied had normal CSF. Contrary to that in adults the outcome in children was excellent, all recovered totally within three months. The present study indicates that acute, peripheral facial palsy is a manifestation of a generalized disorder with subclinical pathology of the central nervous system, and that in children a lumbar puncture should be done, even if there are no signs of meningitis.
Malrotation in Children with Symptoms of Gastrointestinal Allergy and Psychosomatic Abdominal Pain
Authors: KULLENDORFF C. M. , MIKAELSSON C. , IVANCEV K.
Published: January 2008

Three children with malrotation 4.5, 5 and 9 years old at operation are presented. Their preliminary diagnoses were gastrointestinal (GI) allergy, GI allergy with colon irritabile and psychosomatic abdominal pain. They were treated on an outpatient basis under these diagnoses for more than two years before their malrotations were discovered. In two children radiology did not demonstrate any signs of intestinal obstruction and in one of these children repeated radiological examinations were necessary for the diagnosis of malrotation. Operative findings were chronic volvulus with compromised blood flow and obstructive duodenal bands. The third child suffered acute strangulation ileus with gangrene of the intestines before diagnosis was made. We conclude that special consideration must be given to the possibility of malrotation when treating and radiologically investigating children with GI disturbances.
Respiratory Failure and Multiple Fractures in Vitamin D‐Oependent Rickets
Authors: ALPAN G. , MOGLE P. , PATZ D. , AVITAL A. , BAB I.
Published: January 2008

A 20‐month‐old boy presented with multiple fractures and respiratory failure. He was found to have vitamin D‐dependent rickets. The rickets did not improve with phosphate, calcium and calciferol. The rickets healed, however, with large doses of l‐alpha‐hydroxycholecalci‐ferol. The presentation is unusual and the response to therapy suggests metabolic heterogeneity in vitamin D‐dependent rickets.
Near‐Total Pancreatectomy for Hyperinsulinism: Spontaneous Remission of Resultant Diabetes
Authors: GRUPPUSO P. A. , DeLUCA F. , O'SHEA P. A. , SCHWARTZ R.
Published: January 2008

ABSTRACT. Persistent hyperinsulinism in the newborn may warrant surgical intervention to prevent neurologic sequelae. Subtotal pancreatectomy may not be adequate, necessitating near‐total pancreatectomy with subsequent development of diabetes mellitus. We report an infant with hyperinsulinemic hypoglycemia who underwent near‐total pancreatectomy. The postoperative period was characterized by insulin‐dependency and extreme insulin sensitivity. Clinical follow‐up and C‐peptide determinations showed a return of insulin secretory capacity permitting the discontinuation of insulin therapy after five months. This experience reaffirms the potential for a favorable outcome after near‐total pancreatectomy in the newborn period for severe hyperinsulinism.
Bacterial Colonization and Neonatal Infections
Authors: MEBERG A. , SCHØYEN R.
Published: January 2008

In a prospective randomized study different regimens for skin and umbilical disinfection in newborn infants were tested: daily whole body soap wash (control group), daily whole body soap wash and umbilical cleansing with (i) benzine solution, or (ii) 0.05 % chlorhexidine, and daily whole body wash and umbilical cleansing with a 4 % chlorhexidine detergent solution (Hibiscrub®). Bacterial cultures were taken from the nose and umbilical area at discharge. Clinical infections were registered in the nursery, and after discharge until 6 weeks of age. Cultures were taken from infected areas. In the control group a high colonization rate was found for S. aureus (91 %), E. coli (39 %), and group B streptococci (GBS) (20 %). The colonization rates were influenced by the Hibiscrub regimen (colonization rate for S. aureus 59 %, E. coli 23 %, and GBS 10 %), but not by the other regimens. Infections (pemphigus, paronychia, conjunctivitis, umbilical infection) occurred in 12.9 % of the infants, of whom 65 % got infection after discharge from the nursery. 96 % of the infections were caused by S. aureus, and 87 % caused by strains colonizing the infants in the nursery. None of the tested regimens reduced the rate of infections during the first 6 weeks of life.
Constitutional Delay of Growth and Puberty in Boys: The Effect of a Short Course of Treatment with Fluoxymesterone
Authors: STANHOPE R. , BOMMEN M. , BROOK C. G. D.
Published: January 2008

ABSTRACT. 17 boys with delayed growth spurt, 9 of whom also had late puberty, were treated with 2.5 to 5.0 mg of fluoxymesterone daily for 0.23‐0.58 years. Mean increment of growth velocity was 4.5 cm/year during treatment and this was maintained at 3.8 cm/year over a post‐treatment observation period of 0.22‐1.3 years. Mean testicular volume at the end of the treatment period was 9.9 ml. Mean height for bone age standard deviation score remained unchanged at ‐1.2 to ‐1.4 (not significant). We conclude that a low dose of fluoxymesterone may be used in safety for a short time to induce a growth acceleration in adolescent boys with constitutional delay of growth and puberty.
Is the Sweat Test Infallible in Cystic Fibrosis?
Authors: COLLINS J. E. , ROLLES C. J.
Published: January 2008

ABSTRACT. The diagnosis of cystic fibrosis is straight forward if the clinical findings and sweat sodium are considered together. We describe 3 patients where the diagnosis has proved difficult as both the clinical features and sweat sodium have varied between normal and abnormal.
Hyperactive Disorder of Childhood
Authors: SANDBERG SEIJA
Published: January 2008

ABSTRACT. In many European countries hyperkinesis is a relatively rare clinical diagnosis compared with the United States. Though systematic international studies comparing the diagnostic process with regard to this disorder are still lacking, it is likely that the reasons for the vast differences in the rates of the disorder do not lie in the differences of the children's behaviour but in diagnostic practice. Individual components of hyperactivity, namely overactivity, restlessness and poor concentration are common among children attending clinics as well as in randomly selected samples in the general population. Treatment for hyperactivity is largely the same as for the majority of child psychiatric disorders which predominantly involve disturbances of conduct. As the ‘causes’, as well as the factors maintaining the symptoms, are often complex, one form of treatment is seldom adequate. In most cases a combination of psychological and educational treatments is necessary. Stimulant drugs, though in a few instances capable of producing instant and dramatic therapeutic effects, should not be used as a treatment of first choice.
Breast Feeding of Low Birthweight Infants
Authors: VERRONEN PAULA
Published: January 2008

ABSTRACT. The incidence and length of breast feeding of LBW (2 500 grams) infants were investigated. A marked increase from 1979 to 1982 was noted: the incidence rose from 78 % to 91 % and the proportion of infants breast fed for 3 months rose from 54 % to 67 %. A breast feeding promotion programme did not influence the length of breast feeding of LBW infants within one year of the intervention. Smaller infants, those with RDS and those from lower social classes were breast fed less than others.
Carnitine in Maternal and Neonatal Plasma*
Authors: CEDERBLAD G. , NIKLASSON A. , RYDGREN B. , ALBERTSSON‐WIKLAND K. , OLEGÅRD R.
Published: January 2008

ABSTRACT. Total plasma carnitine was analysed in 19 women, with uncomplicated pregnancies, who underwent elective caesarean section, and in their neonates. The women were given a balanced glucose (glucose group) or saline (saline group) infusion, group allocation being on a random basis. The carnitine levels in maternal or infant plasma did not differ between these two groups. At delivery, the mean maternal carnitine value, 17.4±1.25 μmol/l, was lower than the mean infant value, 25.9 μmol/l±2.67 (mean ± SE, p< 0.005) and lower than the mean value in non‐pregnant, fertile women, i.e. 40.9±1.22 μmol/l. The mean carnitine value in the unfed neonate had not changed when the infant was 4 hours old. A positive correlation was found between carnitine levels in maternal and infant plasma (p< 0.01). At delivery, the levels of non‐esterified fatty acids and 3‐OH‐butyrate in infant plasma were different in the two groups, but not at 4 hours of age. The results suggest that the maternal carnitine level is the most important factor governing plasma carnitine levels in the neonate.
Development of B Lymphocyte Function in Childhood
Authors: ANDERSSON U.
Published: January 2008

ABSTRACT. The capacity of blood lymphocytes of children aged from birth to six years to produce immunoglobulins was studied in vitro at the cell level using a direct B lymphocyte activator (Epstein‐Barr virus) or a T lymphocyte dependent B lymphocyte activator (pokeweed mitogen). Umbilical cord blood lymphocytes secreted IgM at adult levels after Epstein‐Barr virus stimulation, while the ability to synthesize IgG and IgA increased up to the ages of 1 and 2 years, respectively, but not beyond this period. IgG3 production preceded that of the other IgG subclasses. The T lymphocyte dependent IgM synthesis was low at birth, but approached adult levels at two years of age. T cell dependent IgG and IgA secretion, however, remained reduced even up to 6 years of age.
Ferritinemia as an Indicator of Systemic Disease Activity in Children with Systemic Juvenile Rheumatoid Arthritis
Authors: PELKONEN P. , SWANLJUNG K. , SIIMES M. A.
Published: January 2008

ABSTRACT.Twenty children with systemic juvenile rheumatoid arthritis, aged 0.9‐13.7 years, were studied with regard to their serum ferritin concentration at diagnosis and during follow‐up, ranging from 2 to 9 years. At diagnosis, during fever, the concentration was extremely high. The median value was 935 μg/l. The values were unrelated to other manifestations of the disease or laboratory findings. During glucocorticoid treatment, the serum ferritin concentrations normalized rapidly, usually within a few weeks. The rate of normalization reflected the response of the fever to treatment. Later, subnormal concentrations were found, which were unrelated to the activity of the arthritis. Thus, serum ferritin is a useful guide when tapering glucocorticoid dosage.
Interactions of Endotoxin with Cortisol and Acute Phase Proteins in Septic Shock Neonates
Authors: TOGARI H. , SUGIYAMA S. , OGINO T. , SUZUKI S. , ITO T. , ICHIKI T. , KAMIYA K. , WATANABE I. , OGAWA Y. , WADA Y. , TAKAOKA T.
Published: January 2008

ABSTRACT. CRP, α1‐acid glycoprotein and haptoglobin were studied in 13 septic shock neonates. Endotoxin was recovered from eight infants. Serum Cortisol concentration from infants with en‐dotoxemia (917 ± 596 ng/ml) was significantly higher than that from infants without en‐dotoxemia (398 ± 239 ng/ml). Serum Cortisol correlated well with immature neutrophil counts denned as the unit “band/neutrophil”. Increased Cortisol level and immature neutrophil counts preceded the elevation of CRP, α1‐acid glycoprotein and haptoglobin in four extremely premature neonates. We conclude that positive interactions between endotoxin, Cortisol and acute phase protein synthesis are present in the initial period of infection, and delayed acute phase protein synthesis is suspected in extremely premature neonates.
Epidemiological Aspects of P‐Fimbriated E. coli
Authors: TULLUS K. , SJÖBERG P.
Published: January 2008

ABSTRACT. In a retrospective study we found an increased incidence of E. coli septicemia and pyelonephritis among children cared for in a special neonatal ward during 1975 and 1976 compared to the following years. The study was undertaken because of a previously reported epidemic outbreak of E. coli pyelonephritis in children cared for in the same neonatal ward during 1979‐1982. The increased incidence of infections seems to be caused by spread of one or several virulent E. coli strains in the ward. Two of the strains causing septicemia were saved. They showed a multiply resistant antibiotic pattern similar to most of the strains causing pyelonephritis among the children born at that time. Their serotype was 04: K3 and they were P‐fimbriated. Septicemia occurred among high‐risk infants at a mean age of five days, while pyelonephritis occurred among uncomplicated cases at a mean age of 3.9 months. The proposed spread of one or several virulent E. coli strains correlates to a high bed occupancy m the ward during that time. r=0.38 (p< 0.01).
Effects of Short‐Term Caloric Restriction on Lactational Performance of Well‐Nourished Women
Authors: STRODE MARGARET A. , DEWEY KATHRYN G. , LÖNNERDAL BO
Published: January 2008

ABSTRACT. Milk volume and composition, nutrient intake and plasma prolactin levels of 22 well‐nourished lactating women were measured during a 3‐week period; an experimental group (E, n=14) reduced energy intake by 19 to 53 % (mean 32 %) during week 2 while controls (C, n=8) maintained normal intake. Mean maternal energy intakes (kcal/day) were: (E) 2316 (wk 1), 1591 (wk 2); (C) 2037, 2121. Mean infant milk intakes (g/day) during these weeks were: (E) 736, 718, 684; (C) 714, 671, 702. Milk intake was not reduced among infants of mothers whose energy intakes were at least 1500 kcal/day during week 2. In group E prolactin levels tended to increase during week 2. Milk composition did not change significantly. Lower energy intakes than those currently recommended appear compatible with successful lactation and gradual maternal weight loss, but longer‐term studies are needed to determine a lower limit for safe intakes.
Longitudinal Evaluations of Psychological Distress in Parents of Children with Malignancies
Authors: MAGNI G. , CARLI M. , De LEO D. , TSHILOLO M. , ZANESCO L.
Published: January 2008

ABSTRACT. The authors evaluated the psychological distress in 41 parents of children with acute lymphocytic leukaemia or with Hodgkin's disease using the Symptom Distress Checklist (SCL‐90). The subjects were tested three times: within the first few days after the child's admission to hospital and 8 months and 20 months later. The experimental population was compared with a control group of 25 subjects matched for age, sex, marital status and social class. At the first evaluation the experimental group had higher mean scores than the controls for obsession, depression, anxiety and sleep disturbances. Seventy‐eight % of the subjects (65.8 % excluding the sleep disturbances (SIDi) subscale) scored moderate distress on at least one of the SCL‐90 subscales. The 8 month and 20 month follow‐ups confirmed the presence of high scores of psychological distress particularly in the sleep disturbances and depression subscales, with 78 % (58.4 % excluding SIDi) and 82.3 % (70 % excluding SIDi) of the subjects gaining scores of moderate distress in at least one of the subscales of the SCL‐90.
Inevitable and Avoidable Deaths in Childhood ALL
Authors: SAARINEN ULLA M. , RAPOLA JUHANI
Published: January 2008

ABSTRACT. The causes of 37 deaths among 100 Finnish children with ALL were analyzed after a median follow‐up of 5 years. Five children died during primary induction, 9 in complete remission, and 23 in hematological relapse. Infections were responsible for 17 deaths, and four deaths were due to toxicity of chemotherapy. In 16 cases ALL relapse was the major cause of death. Ten of the deaths were defined as “avoidable” because they occurred in potentially curable children, i.e., during induction or primary remission. Critical analysis revealed that 5 out of the 10 “avoidable” deaths might indeed have been prevented by appropriate diagnosis and therapy. We want to emphasize the need for continuous education of all pediatricians involved in the care of ALL patients, as well as the importance of best available clinical expertise and centralization of medical therapy in the efforts to diminish the mortality in childhood ALL.
Early Feeding Problems in an Affluent Society
Authors: DAHL M. , SUNDELIN C.
Published: January 2008

ABSTRACT. The aim of this study was to analyse early feeding problems. Fifty infants, between the ages of 3 and 12 months, were reported by the Child Health Centre (CHC) nurse and the parents to have some form of feeding problem, which had been present for at least one month. Data were collected by a visit to the infant's home, from medical records and by interviewing the CHC nurse. Three main problem categories were distinguished: Refusal to eat (28 infants), colic (9 infants) and vomiting (8 infants). The problems had often begun at an early age and had persisted for a long time (mean age at onset 4.3 months, mean duration 4.5 months). Eight of the infants had significant medical disorders, which in seven of them explained the feeding problems. In 23 infants the weight increase had been poor since the commencement of the problems. The CHC nurses considered most of the problems troublesome, difficult to treat and uncommon.
Phagocytosis‐Associated Oxidative Metabolism in Human Milk Macrophages
Authors: SPEER CH. P. , GAHR M. , PABST M. J.
Published: January 2008

ABSTRACT. Evidence exists that human milk macrophages, which are the most abundant cells in milk, play an important role in the protection of the newborn infant against infection. We investigated the oxidative metabolism of milk macrophages by measuring luminol‐dependent chemiluminescence, generation of superoxide anion ((K) and production of hydrogen peroxide (H2O2) in the resting state and after stimulation with opsonized zymosan or phor‐bol myristate acetate (PMA). Generally, macrophages generated luminol‐dependent luminescence, (O2‐) and H2O2 with either stimulus to a similar extent as did blood monocytes. In addition, macrophages killed Escherichia coli and Staphylococcus aureus as effectively as did blood monocytes (–75%, 120 min). Acidification of macrophages in milk (pH 1,30 min) only slightly reduced their PMA‐stimulated production of oxygen radicals. Bacterial killing by macrophages preincubated at pH 1 was about 70% that from controls maintained at pH 7. When macrophages were cultured for several days in endotoxin‐free medium, their ability to produce oxygen metabolites declined. By continuous treatment with bacterial LPS (10 ng/ ml), milk‐macrophages could be “primed” to release large amounts of oxygen intermediates. In addition, the Oi response of macrophages cultured without bacterial products could be partially restored by the addition of LPS to the culture. We conclude that milk macrophages are capable of releasing large amounts of oxygen metabolites, and could contribute to the protection of neonates against bacterial and fungal infections.
Sudden Infant Death Syndrome and Post Perinatal Mortality in Norwegian Birth Cohorts 1967‐1980
Authors: IRGENS L. M. , SKJÆRVEN R.
Published: January 2008

ABSTRACT. The well established effects of maternal age and birth order in sudden infant death syndrome (SIDS) formed the basis for a comparison with other categories of post perinatal death in an attempt to shed some light on the etiologic roles played by ante and postnatal factors. A total of 826162 children, born 1967 through 1980 and recorded at the Medical Birth Registry of Norway was at risk to die during the post perinatal period (ages 7 through 364 days). Out of the 3582 infants who died, 1062 were considered SIDS. Strong effects of maternal age (negative) and birth order (positive) were found in the SIDS group, but not to the same extent in the non‐SIDS group or the group of congenital malformations. Likewise, the excess risk in children of unmarried mothers was higher in the SIDS group. The suggested effects of postnatal factors in the causation of SIDS may seem promising from a preventive point of view. The strength of the effects of maternal age and birth order necessitate adjustment for these variables in future epidemiological studies of SIDS.
Lactoferrin, C‐reactive Protein, α‐1‐Antitrypsin and Immunoglobulin GA in Cerebrospinal Fluid in Meningitis
Authors: GUTTEBERG T. J. , FLÆGSTAD T. , JØRGENSEN T.
Published: January 2008

ABSTRACT. Cerebrospinal fluid measurements of lactoferrin and α‐1‐antitrypsin showed significant elevation in bacterial meningitis in children. 8 of 10 lactoferrin values and 6 of 11 α‐1‐antitrypsin values were above the upper range of controls. Both proteins correlated well with the total number of leukocytes in the cerebrospinal fluid. C‐reactive protein, measured by either agglutination or radial immunodiffusion in the cerebrospinal fluid, failed to demonstrate any asefulness in diagnosing bacterial meningitis. Neither elevated serum C‐reactive protein in cases of bacterial meningitis, nor sepsis, gave detectable concentrations of C‐reactive protein in the cerebrospinal fluid.
Children with Inborn Errors of Phenylalanine Metabolism: Prognosis and Phenylalanine Tolerance
Authors: ALM J. , BODEGÅRD G. , LARSSON A. , NYBERG G. , ZETTERSTRÖM R.
Published: January 2008

ABSTRACT. Twenty‐three children, who were detected by neonatal PKU screening, were followed for 8‐18 years in one paediatric centre. Dietary treatment was started if the blood phenylalanine level exceeded 0.72 mmolA. All 23 infants were initially given a low phenylalanine diet. The growth and development rates of the children did not differ significantly from those in a reference population, although one child had mild mental retardation and another had a short attention span. Fourteen children were still on a strict phenylalanine‐restricted diet on their last follow‐up (at 8‐18 years of age). In nine children who were initially put on a low phenylalanine diet, it was possible to normalize the diet between 1/2 and 10 years of age, while maintaining the blood phenylalanine levels between 0.25 and 0.72 mmol/1. It seems likely that those of our patients who markedly increased their phenylalanine tolerance during childhood had a regulatory mutation of the phenylalanine hydroxylase system. A continuous reevaluation of each child treated with a low phenylalanine diet reduces the use of unnecessarily restricted diets.
Blood Pressure in Puberty
Authors: VARTIAINEN E. , TUOMILEHTO J. , NISSINEN A.
Published: January 2008

ABSTRACT. The effects of sexual maturation, height, weight, body mass index, triceps skinfold and heart rate on systolic and diastolic blood pressure were studied among 13‐year‐old children in North Karelia, Eastern Finland. Cross‐sectional and two‐year longitudinal data were analyzed for 851 children in the six schools participating in the North Karelia Youth Project. In boys, the levels of both systolic and diastolic blood pressure increased during puberty. In girls, the level of systolic blood pressure did not change, but diastolic blood pressure increased as much as in boys. The change in systolic blood pressure was found to be associated with physical growth and stage of sexual maturation. Physical growth seemed to contribute more to the change in the level of systolic blood pressure than the stage of sexual maturation did.
Malnutrition: A Cause of Elevated Sweat Chloride Concentration
Authors: BECK R. , DURIE P. R. , HILL J. G. , LEVISON H.
Published: January 2008

ABSTRACT. In order to document the frequency and causes of elevated sweat chlorides we reviewed all sweat chloride determinations performed over a 2‐year period. Seven hundred and thirty‐five quantitative tests were performed. Three hundred and three positive or borderline results were obtained from 133 patients. Thirty‐three of these patients did not have clinical evidence of CF. Fourteen of them (42%) suffered from malnutrition or growth stunting when tested. The remaining patients who were normally nourished, represented a very heterogeneous group with no unifying diagnosis. Initial sweat chlorides in 11/14 malnourished children were in the abnormal range (>60 mmol/1). These tended to revert to normal coincident with improvement in nutritional status. Less remarkable elevations in sweat chloride levels were noted in the normally nourished patients, since almost 50% (9/19) were in the intermediate range (50‐60 mmol/1). We conclude that malnutrition can be the cause of elevated sweat chlorides, which may lead to an erroneous diagnosis of cystic fibrosis. Clinicians should be aware of this association and adhere to strict criteria for the diagnosis of cystic fibrosis. Also, repeated sweat chloride determinations should be obtained, preferably following re‐nutrition.
Sweat Sodium Related to Amount of Sweat after Sweat Test in Children with and without Cystic Fibrosis
Authors: HJELM M. , BROWN P. , BRIDDON A.
Published: January 2008

ABSTRACT. The sweat concentration of sodium was found to be inversely correlated with the amount of sweat obtained after a sweat test according to the method of Gibson & Cook in children without and with cystic fibrosis. Reference intervals for sweat sodium overlapped for the two groups but two‐dimensional reference distributions for the amount of sweat (range 20‐440 mg) correlated with its sodium content were completely separated. The establishment of similar distributions in centres carrying out sweat tests could serve to assess the performance of this investigation at local level.
Pulmonary Function and Oxygen Uptake during Exercise in 11‐Year‐Old Patients with Cystic Fibrosis
Authors: STANGHELLE J. K. , HJELTNES N. , MICHALSEN H. , BANGSTAD H. J. , SKYBERG D.
Published: January 2008

ABSTRACT. Ten patients with cystic fibrosis (CF), 5 girls and 5 boys, 11 years of age, underwent pulmonary function and bicycle exercise testing. The material includes all but 2 CF patients in this age group in southern and eastern Norway. The CF children had a moderately reduced pulmonary function, the girls more pronounced than the boys. The mean maximal oxygen uptake (max VO2) in the CF boys was 55 ml/kg/min (94% of age predicted value; range 79‐105%), and the CF girls 42 ml/kg/min (79% of age predicted value; range 67‐89%). The mean maximal peak heart rate was 195 beats/min. Only one CF girl showed apparent pulmonary limitation during exercise. Increased ventilatory equivalent for oxygen was found during both rest and exercise for the CF girls, but only during rest for the CF boys. Max VO2 was fairly well related to the habitudinal physical activity of the children (r=0.79).
Renal Tubular Acidosis in a Case of Shwachman's Syndrome
Authors: MARRA G. , APPIANI A. CLARIS , ROMEO L. , MARZORATI D. , VALADE A. , GOJ V. , ASSAEL B. M.
Published: January 2008

ABSTRACT. We describe metabolic acidosis in a 15‐month‐old girl with clinical features of Shwachman's syndrome. Renal function tests indicated that the patient had type 1 renal tubular acidosis. Based on our findings and other reports of renal tubular dysfunction in patients with Shwachman's syndrome, we conclude that it is important to look for a possible renal tubular defect in this syndrome.
Specificity and Sensitivity of Methacholine Challenge Test in Children with Normal and Hyperreactive Airways
Authors: SPIROPOULOS K. , STEVENS J. , EIGEN H. , SPIROPOULOS A.
Published: January 2008

ABSTRACT. To assess the ability of the methacholine challenge test for separation between normals and patients with clinically apparent mild airway hyperreactivity, the provocative dose of inhaled methacholine required to cause a 20% drop in the forced expiratory volume in one second was evaluated in two selected pediatric populations. On the basis of a standardized respiratory questionnaire, 70 subjects, 4‐16 years of age were identified. Included were 49 normal individuals, and 21 individuals with mild airway hyperreactivity who responded to broncho‐dilators. Methacholine inhalation challenges were performed by use of a standard inhalation procedure. Forty‐seven percent of the normals (23/49) had a positive methacholine challenge test while 24% (5/21) of the patients with hyperreactive airways had a negative test by the standard criteria. A wide spectrum of specificity and sensitivity of methacholine challenge was obtained at different doses of methacholine. The greater the sensitivity, the lower the specificity. Therefore, we postulate that the methacholine challenge test can be helpful in making the clinical diagnosis but it does not allow a clear and perfect separation between normal and clinically apparent mildly airway reactive patients in a pediatric age population.
Age‐related Anti‐thyroid Antibodies and Thyroid Abnormalities in Turner Syndrome
Authors: GERMAIN EMILY L. , PLOTNICK LESLIE P.
Published: January 2008

ABSTRACT. One hundred pediatric patients with Turner syndrome were studied to determine the correlation between the presence of anti‐thyroid antibodies with age and karyotype, and the value of anti‐thyroid antibody titers as predictors of subsequent thyroid abnormalities. (54 patients = 45,X; 46 = other karyotypes.) The frequency of positive titers of anti‐thyroid antibodies increased linearly with cumulative age. Anti‐parietal cell and anti‐adrenocortical cell antibodies were not increased in these patients (1.3 and 2.6% respectively). The ability to use positive anti‐thyroid antibody titers to predict the development of thyroid abnormalities increased from age 10 years and became statistically significant at ages 13‐17 years for the whole group as well as 45,X patients. None of the patients had clinical symptoms of thyroid dysfunction although 22% developed thyroid abnormalities, which included elevated TSH, low T4, and/or goiter.
Infantile Spasms and Neuronal Heterotopias
Authors: PALM LARS , BLENNOW GÖSTA , BRUN ARNE
Published: January 2008

ABSTRACT. Six infants with infantile spasms are presented, three primarily considered idiopathic and three symptomatic. Autopsy unexpectedly revealed heterotopias, cortical dyslamination, and other brain malformations in all six cases. No history of any etiologic moment during the neuronal migratory period of early gestation was found. It is concluded that wide‐spread disturbances of CNS morphology should always be considered in cases of infantile spasms.
Hip Joint Instability in Breech Pregnancy
Authors: LUTERKORT MARIE , PERSSON P.‐H. , POLBERGER STAFFAN , BJERRE INGRID
Published: January 2008

ABSTRACT. 222 consecutive fetuses found by ultrasound to be in breech presentation in the 33rd gestational week were followed with repeated examinations in weeks 35 and 38. Ninety‐one of these fetuses persisted in breech presentation until delivery, while cephalic version occurred in 131. The frequency of hip joint instability was 21% in the breech delivered group and 1.5% in the vertex delivered group. The position of the fetal legs was established at each ultrasound examination. The intrauterine fetal attitude was classified as extended when the fetuses had extended knees and maximally flexed hips at all ultrasound examinations. This occurred in 30 breech delivered fetuses, 47% of which developed hip joint instability. Only 8% of the breech born infants with flexed legs in utero developed hip joint instability. It is concluded that instability of the hip joint is a consequence of the intrauterine attitude, rather than of the breech delivery per se.
Early Childhood Hyperkalemia: Variety of Pseudohypoaldosteronism
Authors: APPIANI A. CLARIS , MARRA G. , TIRELLI S. A. , GOJ V. , ROMEO L. , CAVANNA G. , ASSAEL B. M.
Published: January 2008

ABSTRACT. Fractional excretion of electrolytes, renal acidification capacity and the renin‐aldosterone system have been studied in 5 non‐azotemic children, 19‐25 months old, with mineralo‐corticoid resistant hyperkalemia, discovered in the first month of life. Although fractional potassium excretion was similar in patients and in a group of control healthy children (13.8± 5.2% vs. 8.7±6.4%) it was inappropriately low in the patients for their higher potassium concentration. Fractional sodium excretion was significantly increased in the patients (1.6±0.3% vs. 0.67±u.4, p<0.02). Normal net acid and ammonium excretion and intact ability to lower urinary pH during acid loading were observed in all patients. Mean values for plasma aldosterone (37.0±9.1 vs. 13.9±11.2 ng/dl), plasma renin activity (12.5±3.9 vs. 8±2.8 ng/ml/h) and plasma aldosterone/plasma potassium ratio (7.11±1.5 vs. 3.08 ±1.7) were higher in the patients than in the control subjects (all p<0.001). These data support the hypothesis that a partial lack of response of the renal tubule to endogenous mineralocorticoids was present in the patients. This type of pseudohypoaldosteronism is less severe than that described for the classic form and for early childhood renal acidosis.
Infective Endocarditis in Swedish Children
Authors: SCHOLLIN J. , BJARKE B. , WESSTROM G.
Published: January 2008

ABSTRACT. A retrospective study of Swedish children with infective endocarditis (IE) during the period 1971‐80 was made. Sixty‐six instances were identified in 64 children (0.39 cases per 100000 children per year). Fifty (78%) had a previously known heart disease. Most commonly this was a ventricular septal defect and tetralogy of Fallot. Seventy‐one percent had positive blood cultures. Streptococcus viridans and Staphylococcus aureus were most commonly isolated. Twenty‐two percent of the children had undergone previous cardiac surgery. One case closely followed cardiac surgery and in only nine children could a definite port of entry of infection be demonstrated.
Fatal Familial Cholestatic Syndrome in Greenland Eskimo Children
Authors: NIELSEN I.‐M. , ØRNVOLD K. , JACOBSEN B. BROCK , RANEK L.
Published: January 2008

ABSTRACT. A syndrome of intrahepatic cholestasis leading to death in early childhood was studied in 16 Greenland Eskimo children. The pedigrees are compatible with autosomal recessive inheritance. Jaundice, bleeding, pruritus, malnutrition, steatorrhoea, osteodystrophy and dwarfism were typical clinical features. Eight had died between the ages of six weeks and three years due to bleeding or infections. Hyperbilirubinaemia, profound hypoprothrombin‐aemia, thrombocytosis and elevated alkaline phosphatase levels were evident. Serum calcium, phosphate and parathyroid hormone levels indicated a secondary hyperparathyroidism. Hepatic fibrosis developed with increasing age. Follow‐up of the surviving patients was 4 to 30 months. The aetiology of the disease is unknown. The syndrome has some features in common with previously described patients with familial intrahepatic cholestasis. No specific treatment is available. Genetic counselling is essential.
Plasma Exchange: An Important Part of the Therapeutic Procedure in a Small Child with Autoimmune Hemolytic Anemia
Authors: IMGRUETH M. , WAGNER H. P. , PIPCZYNSKI‐SUTER K. , BEGUIN L. , WYSS M. , PFISTER A. M. , STOCK H. K. , OETLIKER O.
Published: January 2008

ABSTRACT. The case history of a child with autoimmune hemolytic anemia with complement activating warm antibodies of the pdl type is presented. This child also had giant cell hepatitis. Although plasma exchange is not curative in such a patient, the removal of antibodies and bilirubin by means of plasma exchange has alleviated the patient's condition on two occasions (at age 19 and 33 months respectively), and has permitted the institution of effective immunosuppression. A technique for plasma exchange is described, which by use of plasma filters and the usual hemodialysis equipment allows to safely perform the procedure in any pediatric hemodialysis unit. Its use in this patient stresses the technical practicability even in very young children. It is suggested that plasma exchange, if indicated, should be considered more often as part of a therapeutic concept.
Weaning Practices in the United Kingdom and Variations in Anthropometric Development
Authors: WHITEHEAD R. G. , PAUL A. A. , AHMED E. A.
Published: January 2008

ABSTRACT. The influence of different weaning practices on the dietary energy intake and growth of Cambridge infants has been investigated. Bottle fed children were in general given solid foods sooner, 10.6 weeks for boys and 13.9 weeks with girls: among breast‐fed babies the average age was 14.9 weeks in the case of boys and 17.4 weeks for girls. All four groups of children exhibited different growth patterns from those of the NCHS and Tanner reference curves. Over the first three months both boys and girls exhibited a faster velocity of growth in weight, length and weight‐for‐length. After this time, however, growth velocity was slower than that of the reference children particularly among breast‐fed boys who were not given solids until after 16 weeks. For most of infancy triceps and subscapular skinfold thicknesses remained around the 10th centile of the corresponding Tanner reference children, although again the babies weaned later had the lower values. Bottle‐fed infants had growth patterns similar to those of the earlier weaned breast‐fed babies for all parameters. It is concluded that babies grow differently now that infant feeding patterns have changed.
Severe Undernutrition in Jamaica Kwashiorkor and Marasmus: the Disease of the Weanling
Authors: JACKSON ALAN A.
Published: January 2008

ABSTRACT. The syndromes of severe undernutrition, marasmus and kwashiorkor, have causes related to the interplay of social and medical considerations in the society. Kwashiorkor supervenes when the individual is exposed to a level of stress that exceeds the body's ability to cope. One final common pathway, through which a variety of environmental factors exert an effect, may be associated with oxidant damage to cells. In kwashiorkor there is a severe decrease in the level of both oxidised and reduced glutathione in the red cell. This could be caused by a decreased production, increased consumption or a combination of the two. This is discussed with specific reference to the metabolism of glycine and the possible causal relationship to the pathophysiology of the disease process.