bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of home‐based peer counselling to promote breastfeeding in the northeast of Brazil: A randomized clinical trial
Authors: Madeiro Leite Álvaro J , Fiorini Puccini Rosana , Atalah Álvaro N , Alves Da Cunha Antonio L , Tavares Machado Márcia
Published: August 2010

Aims: To evaluate the effectiveness of home‐based peer counselling to increase breastfeeding rates for unfavourably low birthweight babies. Methods: Randomized clinical trial carried out in maternity hospitals and households in Fortaleza, one of the regions in Brazil with very low income; 1003 mothers and their newborns were selected in eight maternity hospitals. Newborns needed were healthy and weighed less than 3000 g. Intervention: Breastfeeding counselling, conducted by lay counsellors from the community, during home visits carried out on days 5, 15, 30, 60, 90 and 120 after birth. Main outcome measure: Feeding methods in the fourth month of life. Results: The intervention increased exclusive breastfeeding (24.7% vs 19.4%; p=0.044), delayed the introduction of formula and increased the time infants substituted breastfeeding to bottle milk (bottle milk 33.4% in the control group and 20.1% in the intervention group; p=0.00002). When comparing the frequency of artificial breastfeeding versus all other forms of breastfeeding (exclusive+predominant+partial), the intervention increased breastfeeding rates in 39% (RR=0.61; CI 95%: 0.50–0.75); 15% of children were free from artificial feeding (absolute risk reduction). The number of families to be visited to avoid one child receiving artificial feeding (NNT) was 7 (CI 95%: 5–13).

Conclusions: Breastfeeding counselling, promoted by lay counsellors, can impact favourably on exclusive breastfeeding rates and contribute to delaying the utilization of milk formula and weaning. The intervention has great application potential because most cities in the northeast of Brazil count on community health workers that could do the counselling.
Italian paediatricians and off‐label prescriptions: Loyal to regulatory or guideline standards?
Authors: Pandolfini Chiara , Campi Rita , Clavenna Antonio , Cazzato Teresa , Bonati Maurizio
Published: August 2010

Aim: To evaluate the reason off‐label use exists in paediatric general practice and to distinguish between non‐compliance with respect to regulatory standards and non‐compliance with respect to guidelines in order to determine what this difference means in terms of rational prescribing. Methods: Information on patients visited by 35 general paediatricians in southern Italy was collected and their prescriptions analysed for off‐label status. Off‐label drug use in the Italian paediatric community setting was assessed. A sample indication, pharyngotonsillitis, was chosen and the related prescriptions analysed, distinguishing between non‐compliance with regulatory standards (i.e. off‐label use) and non‐compliance with guidelines, in order to determine the appropriateness of prescribing. Results: Information was collected on 9917 patients (8476 prescriptions). In all, 17% of prescriptions were off label. When the 1675 pharyngotonsillitis prescriptions were analysed, 8% were off label and 63% were not in accordance with the guidelines. On the other hand, 55% of these prescriptions did not adhere to the guidelines, but were not off label either.

Conclusion: The results of this study were surprising because off‐label drug use for pharyngotonsillitis, a common paediatric condition, was low, while non‐adherence to guidelines was high. In cases such as this one, in which guidelines exist, physicians' prescribing habits were irrational because they did not follow the evidence. Physicians should keep up to date with new knowledge and should be provided with updated product information.
Streptococcal toxic shock syndrome in children without skin and soft tissue infection: Report of four cases
Authors: Chiang Ming‐Chou , Jaing Tang‐Her , Wu Chang‐Teng , Hsia Shao‐Hsuan , Chiu Cheng‐Hsun
Published: August 2010

Streptococcal toxic shock syndrome is a fulminant, highly fatal disease characterized by evidence of group A β‐haemolytic streptococcus infection and early shock with consecutive organ failure. In adults, affected individuals usually have preceding skin or soft tissue infection. However, in paediatric patients, except for varicella, the background focus is usually respiratory tract infection, and early diagnosis of streptococcal toxic shock syndrome in such patients is difficult. We report four previously healthy children with streptococcal toxic shock syndrome. Pharyngitis was identified in three cases. All of them had constitutional symptoms such as fever, vomiting, diarrhoea, abdominal pain and physical findings of tachycardia and diffuse abdominal tenderness, but no concomitant skin infection.

Conclusion: Streptococcal toxic shock syndrome should be considered in paediatric patients with fever, vomiting, diarrhoea, abdominal pain and early shock. Early diagnosis, prompt initiation of antibiotics and aggressive fluid therapy are lifesaving for such patients.
Prothrombin and intraventricular haemorrhage
Authors: Fellman Vineta
Published: August 2010

In the study by Salonvaara et al., low prothrombin activity in preterm infants was associated with intraventricular haemorrhage (IVH). The interesting research question—do preterm infants who develop IVH have underlying coagulation disturbance?—could not be answered in this study.

Conclusion: The association needs further investigation. The role of prothrombin in perinatal brain damage in the development of IVH and of white matter damage has to be further elucidated.
Somatostatin treatment of congenital chylothorax may induce transient hypothyroidism in newborns
Authors: Maayan‐Metzger Ayala , Sack Joseph , Mazkereth Ram , Vardi Amir , Kuint Jacob
Published: August 2010

Aim: To describe a group of neonates with congenital, non‐traumatic chylothorax, one of whom developed transient hypothyroidism following treatment with somatostatin. Methods: The charts of seven infants with congenital chylothorax were reviewed in terms of their clinical presentation, the severity of their disease, the complications they presented and the duration of their hospitalization. Their pituitary–thyroid axis function was monitored in particular. Results: The seven infants, all preterm (32–34 wk), suffered from congenital chylothorax and hydrops fetalis diagnosed during the prenatal period. Four were treated by intrauterine drainage, and four had congenital malformations. Hospitalization lasted from 32 to 120 d. Three of the infants suffered from thrombocytopenia, three had chronic lung disease, and one suffered from Gram‐negative sepsis. The infant treated with somatostatin initially had normal thyroid function, but later developed primary transient hypothyroidism and was treated with L‐thyroxine. The thyroid screening tests for the infants who were not treated with somatostatin were all normal.

Conclusions: Repeated doses of somatostatin were effective in reducing chylus production. Administering this treatment earlier should be considered in order to minimize known complications. The only potential side effect observed was primary transient hypothyroidism. Therefore, careful monitoring of the pituitary–thyroid axis is advised.
Host defence lectins in preterm neonates
Authors: Hilgendorff Anne , Schmidt Reinhold , Bohnert Anette , Merz Catherine , Bein Gregor , Gortner Ludwig
Published: August 2010

Aim: Deficiency in collectins is discussed as a risk factor for pulmonary and systemic infections in children and adults. The objective of this study was to determine serum concentrations of surfactant protein D (SP‐D) and mannose‐binding lectin (MBL) in preterm and term infants at birth. Methods: 47 preterm infants below 32 wk gestational age (GA) and 19 healthy, term newborn infants at birth have been included in the study, and SP‐D as well as MBL concentrations have been determined in umbilical cord blood samples using sandwich ELISA technique. In addition, SP‐D concentrations were assessed in tracheal aspirates (TA) of 24 mechanically ventilated preterms and in infants without pulmonary complications before elective surgery. Results: MBL serum concentrations were significantly lower in preterms <32 wk GA (756.7 ng/ml; 14.6–11 184 ng/ml) compared to term newborns (3168.9 ng/ml; 282.3–7679.5 ng/ml; p=0.005; median and range, respectively). Serum SP‐D concentrations were significantly decreased in preterms between 28 and 32 wk GA (1.4 ng/ml; 0–4.6 ng/ml; n=26) compared to term infants (2.2 ng/ml; 1.2–3.3 ng/ml; p=0.05) and were found to positively correlate with history of antenatal corticosteroids and chorioamnionitis. SP‐D concentrations in TA were increased in preterm infants between 28 and 32 wk GA with respiratory distress syndrome (RDS) (25.0 ng/ml; 0.9–44.7 ng/ml; n=12) compared to control subjects (6.6 ng/ml; 0.5–30.4 ng/ml; n=12) in contrast to extremely immature infants <28 wk GA suffering from RDS (4.4 ng/ml; 0.8–78.4 ng/ml; n=12).

Conclusion: In preterm infants, significant changes occur in collectin umbilical cord blood concentrations and pulmonary SP‐D levels. Functional aspects of these findings need to be addressed further.
Inflammatory chemokine expression in the peripheral blood of neonates with perinatal asphyxia and perinatal or nosocomial infections
Authors: Fotopoulos Spyros , Mouchtouri Alexia , Xanthou Georgina , Lipsou Niki , Petrakou Eftichia , Xanthou Marietta
Published: August 2010

Aim:The inflammatory response induced by perinatal infections and asphyxia is considered to participate in neonatal brain damage. Inflammatory responses are characterized by the expression of chemokines. Although chemokine levels have been investigated in healthy newborns, their role during neonatal pathological conditions has not been studied. The aim of our study was to examine chemokine serum levels in asphyxiated and infected neonates.Methods:Peripheral blood samples were obtained from perinatally asphyxiated and infected neonates during the first days of life and from neonates who developed nosocomial infections. Serum levels of interleukin‐8 (IL‐8), interferon‐γ‐inducible protein‐10 (IP‐10), monocyte chemoattractant protein‐1 (MCP‐1), macrophage inflammatory protein‐1α (MIP‐1α), and regulated upon activation, normal T cells expressed and secreted (RANTES) were determined.Results:In perinatally asphyxiated neonates, IL‐8 levels were significantly elevated on the 1st day of life. In perinatally infected neonates, IL‐8 and IP‐10 levels were significantly increased on the 1st day of life, while RANTES levels were significantly lower and remained so until the 4th day. In nosocomially infected neonates, IL‐8, IP‐10 and MIP‐1α levels were significantly increased on diagnosis of infection.

Conclusion:The neonatal immune system is able to produce chemokines for the induction of an inflammatory response during perinatal asphyxia and perinatal or nosocomial infections. Blockade of inflammatory chemokines could possibly contribute to the prevention of brain damage.
Intraventricular haemorrhage in very‐low‐birthweight preterm infants: Association with low prothrombin activity at birth
Authors: Salonvaara Marjut , Riikonen Pekka , Kekomäki Riitta , Vahtera Elina , Mahlamäki Eija , Kiekara Olan , Heinonen Kirsti
Published: August 2010

Aim: To determine the occurrence of intraventricular haemorrhage (IVH) and its association with coagulation factors at birth in preterm neonates born before 30 wk gestation. Methods: 38 neonates (median gestational age 27 wk, range 24–29 wk; median birthweight (BW) 933 g, range 515–1760 g) admitted to the neonatal intensive care unit were studied. Blood samples for coagulation factors were taken within 2 h after birth. The first cranial ultrasonographic examination was performed within the first 3 d. The occurrence of IVH was tested statistically by the Mann‐Whitney U‐test for association with the activity of coagulation factors and clinical variables. Results: Thirteen IVHs occurred within the first 3 d of life. IVH was associated with BW <1000 g (p=0.012), low mean blood pressure within the first 2 d (p=0.026), gestational age <27 wk (p=0.054), low Apgar scores (<7) at 1 min (p=0.078) and intrauterine growth restriction (p=0.072). At birth (samples drawn with a median of first 36 min of life), infants with subsequent IVH had statistically significantly lower prothrombin (factor II) activity (p=0.024) than infants without IVH.

Conclusion: The measured low prothrombin may have been affected by a prior bleeding event. Nevertheless, preterm infants with low prothrombin activity may be susceptible to IVH, or to the progression of it, if left undiagnosed.
Breastfeeding and intelligence of preschool children
Authors: Slykerman RF , Thompson J M D , Becroft D M O , Robinson E , Pryor JE , Clark PM , Wild CJ , Mitchell EA
Published: August 2010

Aim: To investigate whether breastfeeding during infancy is a determinant of intelligence at 3.5 y. Methods: Five hundred and fifty European children enrolled at birth in the Auckland Birthweight Collaborative Study were assessed at 3.5 y of age. Approximately half were small for gestational age (SGA10th percentile) at birth and half were appropriate for gestational age (AGA>10th percentile). Duration of breastfeeding was recorded at maternal interview, and the intelligence of children was assessed using the Stanford Binet Intelligence Scale. Regression analysis was used to calculate estimates of difference in intelligence scores between breastfeeding groups for the total sample and the group of SGA children. Analyses of the total sample were weighted to account for the disproportionate sampling of SGA children. Results: Breastfeeding was not significantly related to intelligence scores in the total sample despite a trend for longer periods of breastfeeding to be associated with higher intelligence scores. However, in the SGA group, breastfeeding was significantly related to IQ at 3.5 y. Small for gestational age children who were breastfed for longer than 12 mo had adjusted scores 6.0 points higher than those who were not breastfed (p=0.06).

Conclusion: Breastfeeding may be particularly important for the cognitive development of preschool children born small for gestational age.
Somatic factors at 8 years of age in children with recurrent use of antibiotics in early infancy
Authors: Louhi‐pirkanniemi Katri , Rautava Päivi , Aromaa Minna , Sahlberg Anna , Mertsola Jussi , Helenius Hans , Sillanpää Matti
Published: August 2010

Aim: To examine the influence of recurrent therapy with antibiotics (RTA) in infancy on children's somatic factors at 8 y of age. Methods: Subject selection was based on stratified randomized cluster sampling. Altogether 1287 infants were potential participants in the follow‐up study. Children with 6 courses of antibiotics (100 children) during their first 18 mo of life and children with no (62%) or 2 courses (38%) of antibiotics participated in a clinical examination in a case‐control setting (100 matched controls) at the age of 8 y. Results: The children with RTA continued to have more infections and had had more courses of antibiotics compared to controls during the follow‐up. There was no clinically significant difference in the somatic and dental status at the age of 8 between the two groups. The parents of the children with RTA reported significantly more often recurrent infections than the parents of the controls.

Conclusions: The children with recurrent therapy with antibiotics in early childhood also continue to be prescribed more antibiotics in later childhood when compared to those who received no or few antibiotics in infancy. However, recurrent infections and medications do not seem to have a marked effect on the somatic and dental status of these children at 8 y of age.
Bone resorption in infants of diabetic mothers
Authors: Lapillonne Alexandre , Glorieux Francis H , Salle Bernard L
Published: August 2010

Aim: Previous studies, using different techniques, have yielded contradictory findings concerning whether bone remodelling is altered in infants of diabetic mothers (IDM). The objective of the study was to assess the bone resorption of IDM during the first 3 mo of age. Methods: We conducted a longitudinal study using a specific index of bone resorption, urinary excretion of collagen type I cross‐linked N‐telopeptide (NTX), to compare bone resorption of a cohort of IDM and that of age‐matched controls throughout the first 3 mo of life. Results: NTX/Cr ratio in IDM followed the same pattern over time as observed in control infants, i.e., a rapid increase during the first 10 d of life, a peak at 1 mo of life, and then a progressive decrease at 3 mo of life. There was no statistically significant difference between urinary NTX excretion observed in IDM and that observed in controls at any age studied.

Conclusion: By using urinary NTX excretion, normal bone resorption was found in IDM throughout the first 3 mo of life.
Clinical presentation and follow‐up of patients with the attenuated phenotype of mucopolysaccharidosis type I
Authors: Vijay Suresh , Ed Wraith J
Published: August 2010

Aim: To review the heterogeneity and severity of the clinical features at the attenuated end of the mucopolysaccharidosis (MPS) type I disease spectrum. Methods: The course of disease in 29 patients with attenuated mucopolysaccharidosis I who attended the MPS clinic in Manchester, UK, was reviewed. Results: For more than half of the patients, onset of symptoms was in the first 2 y of life, and the age at diagnosis ranged from 15 mo to 40 y. Joint stiffness, corneal clouding, umbilical hernia and recurrent ear, nose and throat symptoms were the commonest features at presentation. Patients experienced significant morbidity during the course of this inherited disease. Skeletal problems predominated and cardiac valve pathology, upper airway obstruction and hearing deficits were detected in a notable number of patients. Nerve decompression for carpal tunnel syndrome, cervical cord decompression, and grommet insertion for serous otitis media were the most frequent surgical interventions.

Conclusion: Clinical presentation of attenuated (“non‐Hurler”) mucopolysaccharidosis type I is heterogeneous in time of onset and types of clinical features. A better understanding of the spectrum of disease and of the related disease progression will contribute to more accurate diagnosis, and patients will benefit from early intervention.
Implementation of kangaroo mother care: A randomized trial of two outreach strategies
Authors: Pattinson Robert C , Arsalo Irmeli , Bergh Anne‐Marie , Malan Atties F , Patrick Mark , Phillips Noel
Published: August 2010

Aim: To test whether a well‐designed educational package on the implementation of kangaroo mother care (KMC) used on its own can be as effective in implementing KMC in a healthcare facility as the combination of a visiting facilitator used in conjunction with the package. Setting: Thirty‐four hospitals in KwaZulu‐Natal Province, South Africa. Method: The hospitals were paired with respect to their geographical location and annual number of births at the facility. One hospital in each pair was randomly allocated to receive either the implementation package alone (group A) or the implementation package and visits from a facilitator (group B). Hospitals in group B received three facilitation visits. All hospitals were evaluated by a site visit 8 mo after launching the process and were scored by means of a progress‐monitoring tool. Outcomes: Successful implementation was regarded as demonstrating evidence of practice (score>10) during the site visit. Results: Group B scored significantly better than group A (p<0.05). All 17 hospitals in group B demonstrated evidence of practice, with the median score of the group being 15.44 (range 10.29–22.94). Twelve of the hospitals in group A demonstrated evidence of practice and the median score was 11.33 (range 1.08–21.13).

Conclusion: Successful implementation was achieved in most of the hospitals irrespective of the strategy used. However, facilitation with an implementation package was clearly superior to using a package alone. Some sites do not need facilitation for successful implementation.
Bronze baby syndrome and the risk of kernicterus
Authors: Bertini Giovanna , Dani Carlo , Fonda Claudio , Zorzi Carlo , Rubaltelli Firmino F
Published: August 2010

Aim: The problem of kernicterus in infants with bronze baby syndrome (BBS) has been reviewed on the basis of cases reported in the literature. In addition, a new case concerning an infant with severe Rh haemolytic disease, who presented with BBS and who has developed neurological manifestations of kernicterus with magnetic resonance images showing basal ganglia abnormalities, is presented. In this patient, the total serum bilirubin (TSB) concentration ranged from 18.0 to 22.8 mg/dl (306 to 388 μmol/l) and the bilirubin/albumin (B/A) ratio was 6.0 (mg/g) (6.8 is the value at which an exchange transfusion should be considered). The case presented is important due to the fact that kernicterus appeared after an exchange transfusion was performed when the TSB level reached 22.8 mg/dl (388 μmol/l) on 6th day of life while the haematocrit was 30%. From this case and from other cases reported in the literature, we must stress that, even if the level at which hyperbilirubinemia poses a threat remains undefined, BBS may constitute an additional risk of developing kernicterus.

Conclusion: The possible strategies for implementing an approach to the management of hyperbilirubinemia (especially the haemolytic kind) in the presence of BBS may include an exchange transfusion carried out at lower TSB concentration than previously recommended or an early administration of Sn‐mesoporphyrin.
Breastfeeding and the Baby Friendly Hospitals Initiative (BFHI): Organization, response and outcome in Sweden and other countries
Authors: Hofvander Yngve
Published: August 2010

The Baby Friendly Hospitals Initiative (BFHI), organized as a global campaign by UNICEF and focusing mainly on the breastfeeding routines, attitudes and knowledge among staff and mothers at maternity centres, was introduced in Sweden in 1993. Four years later, all of the then 65 maternity centres had been designated “baby friendly” (BF). Concomitant with that, the 6‐mo breastfeeding rate increased from about 50% to 73% on a national basis, presumably resulting from adherence to the “10 steps” and the development of a favourable breastfeeding climate. The BFHI has engaged practically all countries throughout the world with close to 20 000 maternity centres. On a global scale, about 30% of these maternity centres have been awarded BF status but with large variations between regions and countries; Europe and other industrialized areas being among the lowest.

Conclusion: Strong government support, an organized central lead group and support from the medical profession are necessary prerequisites for BFHI success, but continued work is necessary for sustaining attitudes and knowledge.
Food choices at lunch during the third year of life: Increase in energy intake but decrease in variety
Authors: Nicklaus Sophie , Chabanet Claire , Boggio Vincent , Issanchou Sylvie
Published: August 2010

Aim: Modelling the evolution between the ages of 2 and 3 y of the energy intake and the variety of free food choices at lunch time in relation to children's and context variables. Methods: One‐year follow‐up from 2 to 3 y old. In a nursery canteen, food choices at lunch were recorded by trained assistants who monitored portion size. Energy intake and food variety were estimated. Three hundred and ninety‐five children were studied, for 112 meals and over 10 mo on average. Mixed models of analysis of variance were used to take into account the longitudinal character of the data. Results: From 2 to 3 y, energy intake increased. Variety decreased during the first 7 mo and then remained constant. The individual variability in mean values and in evolution was high for both variables. Energy was positively linked to BMI at 2 y. Variety was slightly higher for girls and increased with duration of breastfeeding. Energy was higher in September to November than in December–January. Variety was maximal in December–January and in June–July.

Conclusion: During the third year of life, while energy intake increases, the restriction of food variety appears to be a normal transition phase. Long duration of breastfeeding is associated with higher food variety.
A clinical decision rule for management of streptococcal pharyngitis in low‐resource settings
Authors: Steinhoff Mark C , Fischer Walker Christa , Rimoin Anne W , Hamza Hala S
Published: August 2010

Background: Most of the world's children live in regions where laboratory facilities are not available. In these regions, clinical prediction rules can be useful to guide clinicians' decisions on antibiotic therapy for streptococcal pharyngitis, and to reduce routine presumptive antibiotic therapy for all pharyngitis. Methods: Prospective cohort study to assess diagnostic signs and develop a prediction rule. Bivariate and multivariate analyses were used to develop clinical rules. Participants were 410 children in Cairo, Egypt, aged from 2 to 12 y, presenting with complaint of sore throat and whose parents provided consent. Main outcome measures included presence of signs and symptoms, and positive group A beta hemolytic streptococcal (GABHS) culture. Results: 101 (24.6%) children had positive GABHS culture. Pharyngeal exudate, tender or enlarged anterior cervical lymph nodes, season, absence of rash, or cough or rhinitis were associated with positive culture in bivariate and multivariate analyses. Three variables (enlarged nodes, no rash, no rhinitis), when used in a cumulative score, showed 92% sensitivity and 38% specificity in these children.

Conclusions: The proposed three‐variable clinical prediction rule for GABHS may be useful when diagnostic laboratories are not available. In this setting, the rule identified more than 90% of true cases. Compared to universal treatment of all pharyngitis, the rule will reduce antibiotic use in GABHS‐negative cases by about 40%.
Risk factors of primary thyroid dysfunction in early infants born to mothers with autoimmune thyroid disease
Authors: Fu Junfen , Jiang Youjun , Liang Li , Zhu Hong
Published: August 2010

Aim: To assess whether the state of maternal thyroid function and the pattern of thyroid alterations during gestation would affect the infants' thyroid function and to evaluate the risk factors affecting early infants' thyroid function by means of multiple logistic regression. Methods: In a cross‐sectional study, 78 neonates born to mothers with Graves disease or Hashimoto thyroiditis were examined and followed clinically and biochemically. Neonates born to healthy mothers during the same period were set as controls. Tests of thyroid function, antithyroid peroxidase antibody (TPOAb), antithyroglobulin antibody (TGAb), anti‐TSH receptor antibody (TRAb) and antithyroid‐stimulating antibody (TSAb) were performed both in early infants and their mothers. All possible maternal and/or infantile risk factors for thyroid dysfunction during early infancy were analysed by means of multiple‐factor logistical regression. Results: The overall prevalence of underlying subtle thyroid abnormalities in these 78 infants was 52.6%, which was significantly higher than that witnessed among infants from healthy mothers (5.4‰, p<0.01). By using multiple logistic regression analysis, the state of maternal thyroid function in gestation, the type of autoimmune thyroid disease during pregnancy and the level of TRAb in the newborn were significantly correlated with the early infants' thyroid dysfunction.

Conclusion: Maternal autoimmune thyroid disease during pregnancy will affect infant thyroid function. Therefore, appropriate management of maternal autoimmune thyroid disease throughout pregnancy is essential in the prevention of undesirable neonatal outcomes.
Glucocorticoid eye drops inhibit growth in the newborn rabbit
Authors: Kugelberg Maria , Shafiei Kayvan , Ohlsson Claes , Sävendahl Lars , Zetterström Charlotta
Published: August 2010

Aim: To investigate if postoperative treatment with dexamethasone eye drops has the capacity to affect longitudinal growth in newborn rabbits. Methods: Thirty‐four male and female rabbits had clear lens extraction performed in one eye at 3 wk of age and were then treated either intensively (group 1) or less intensively (group 2) with de‐escalating doses of dexamethasone eye drops for 8 wk (average doses 0.27 and 0.10 mg/kg body weight/day, respectively). The control group (group 3) received vehicle eye drops only. Body weight and crown–rump length were recorded every week. After 8 wk of treatment, all rabbits were killed and the left femur was measured. Results: Rabbits treated with dexamethasone eye drops gained weight slower (711±42 and 989±153 g weight increase for groups 1 and 2, respectively) than control animals (group 3; 1224±87 g weight increase; p<0.001 vs group 1, p<0.01 vs group 2). Longitudinal growth, determined as increase in crown–rump and femur lengths, was impaired by dexamethasone eye drops in a dose‐dependent way. Crown–rump length increased by 8.25±0.86, 10.90±1.19 and 15.35±1.31 cm in groups 1, 2 and 3, respectively (p<0.001 for all comparisons). At endpoint, i.e. after 8 wk of treatment, the average femur length was 6.36±0.21, 7.39±0.27 and 8.37±0.28 cm in groups 1, 2 and 3, respectively (p<0.001 for all comparisons).

Conclusion: Dexamethasone, administered topically as eye drops, has systemic effects and impairs longitudinal growth in young rabbits. Therefore, we propose that growth should be closely monitored in all children intensively treated with glucocorticoid eye drops.
Age‐ and sex‐specific body composition of Chinese children
Authors: Li S , Zhang M , Yang S , Okada Tomoo , Iwata F , Harada K
Published: August 2010

We examined age‐ and sex‐specific body compositions of Chinese children by the bioelectrical impedance method. The subjects were a total of 587 children aged 6–14 y who had normal relative weight. In all ages, boys had larger fat‐free mass and lower percent body fat (%BF) than girls did. Even in the subjects with BMI <20 kg/m2, more than one quarter of them had high %BF.

Conclusion: Chinese children may have higher %BF than that predicted by BMI.
Recurring acute abdominal pains in an adolescent as the presenting manifestations of hereditary angioneurotic oedema
Authors: Foix‐L'Hélias Laurence , Weiss Laurence , Mollet‐Boudjemline Alix , Fallik David , Trioche‐Eberschweiler Pascale , Labrune Philippe
Published: August 2010

An adolescent was hospitalized for recurring abdominal pains, which had previously led to appendicectomy. Laboratory data finally led to the diagnosis of hereditary angioneurotic oedema, after several hypotheses had been raised and ruled out.

Conclusions: Angioneurotic oedema is a rare condition, which should be suspected in children with recurring abdominal pains, especially when there is liquid within the peritoneal cavity.
A non‐handicapped cohort of low‐birthweight children: Growth and general health status at 11 years of age
Authors: Elgen Irene , Johansson Kjell A. , Markestad Trond , Sommerfelt Kristian
Published: August 2010

Aims: To describe and compare physical growth, current health status, functional limitations and neurodevelopmental impairments (defined as low IQ, school problems or psychiatric disorder) at 11 y of age in a population of non‐handicapped low‐birthweight (LBW) children with that of normal‐birthweight (NBW) children. Methods: A population‐based sample of 130 LBW children (weighing less than 2000 g at birth) without major handicaps, and a random sample of 131 NBW children born at term. Somatic and mental health and cognitive abilities were assessed through questionnaires to parents, a physical examination, standardized tests of cognitive function (WISC‐R) and a semi‐structured interview (Children Assessment Schedule). Results: General somatic health status was similar for the LBW and NBW children. The LBW children were shorter (mean difference −2.5 cm; 95% CI −0.9 to −4.2) and had a smaller head circumference (mean difference −0.8 cm; 95% CI −0.4 to −1.1) but similar weights and body mass indices. Differences and similarities in anthropometric measures were the same at 5 and 11 y of age. The LBW children had higher systolic (mean difference 3.2 mmHg; 95% CI −0.6 to −0.3) but similar diastolic blood pressure. A higher proportion of LBW children had decreased visual acuity and hearing impairment. Forty per cent of LBW children had neurodevelopmental impairments, compared to 20% of NBW children (OR 2.6; 95% CI 1.5 to 4.5).

Conclusion: At 11 y of age, survivors of moderately low birthweight without major handicaps may have generally good health, but are at risk of neurodevelopmental impairments.
Clinical implication of hiatal hernia in patients with right isomerism
Authors: Hsu Jui‐Yu , Chen Shyh‐Jye , Wang Jou‐Kou , Ni Yen‐Hsuan , Chang Mei‐Hwei , Wu Mei‐Hwan
Published: August 2010

Objective: Despite a reported association between hiatal hernia in patients with heterotaxy syndrome, the clinical significance has remained unclear. Based on large patient cohorts, this study specifically aimed at defining the implication of hiatal hernia in patients with right isomerism. Methods: From 1994 to 2002, 143 patients were identified as having right isomerism. Among them, 119 received ultrafast computed tomography (CT) to determine the presence of hiatal hernia as well as any cardiovascular anomalies. Results: Hiatal hernia was found in 17 patients (seven females and 10 males, 14.3%). The upper gastrointestinal (GI) series in six patients confirmed the diagnosis of hiatal hernia in all and revealed severe gastro‐oesophageal reflux in four. The most common symptom of hiatal hernia was vomiting (47%), followed by recurrent bronchiolitis or pneumonia (41.2%) and upper gastrointestinal bleeding (11.8%). Three patients with hiatal hernia underwent fundoplication for medically refractory vomiting. Seven patients were found to have midgut malrotation (5.9%), and four of these had both hiatal hernia and malrotation. Pulmonary atresia was closely associated with the presence of hiatal hernia (p=0.02). One patient with hiatal hernia died suddenly at 6 mo. However, overall mortality was similar between those patients with hiatal hernia and those without.

Conclusions: The incidence of hiatal hernia was considerably high in patients with right isomerism, especially in those with pulmonary atresia, and it is this that may have led to vomiting and recurrent airway infections. While an association between sudden death and hiatal hernia may well exist, this does require further clarification.
Intra‐ and interindividual variability of glucuronidation of paracetamol during repeated administration of propacetamol in neonates
Authors: Allegaert Karel , Hoon Jan De , Verbesselt Rene , Vanhole Christine , Devlieger Hugo , Tibboel Dick
Published: August 2010

Background:Major changes in drug clearance and metabolism are observed during infancy, in part based on ontogenic regulation of various metabolic pathways. Since paracetamol provides a good substrate to study UGT (1A6) activity, urinary metabolites of propacetamol were determined in neonates in whom propacetamol was repeatedly administered.Methods:Paracetamol glucuronide (APAP‐G), paracetamol sulphate (APAP‐S) and free paracetamol were determined in urine samples of neonates during repeated administration of propacetamol. Spearman rank and linear multiple regression (MedCalc®, Mariakerke, Belgium) were used to study the effect of postnatal age, of postconceptional age and of repeated administration on the relative contribution of APAP‐G to overall urine paracetamol (APAP‐G+APAP‐S+free paracetamol) elimination (G/T ratio).Results:147 samples were collected in 23 neonates. Molar median G/T ratio was 14% (range 1–53). Besides increasing G/T ratio with increasing postnatal (p<0.0001) and postconceptional age (p<0.01), repeated administration (p<0.01) also correlated with an increasing G/T ratio, and repeated administration remained significant (p<0.01) after correction of postnatal and postconceptional age in a multiple regression model.

Conclusion:Major variability in the ontogeny of UGT activity to overall elimination of paracetamol was documented in neonates. Besides postnatal and postconceptional age, a significant effect of repeated administration on UGT activity was documented.
Chronic zinc toxicity in an infant who received zinc therapy for atopic dermatitis
Authors: Sugiura Tokio , Goto Kenji , Ito Kouichi , Ueta Akihito , Fujimoto Shinji , Togari Hajime
Published: August 2010

In Japan and many other industrialized countries, zinc is readily available as a nutritional supplement, for cosmetic purposes and for the treatment of atopic dermatitis. The potential risks associated with its use are not, however, fully recognized. As a reciprocal relationship exists between copper and zinc, excessive zinc can produce hypocupraemia, which can cause anaemia and neutropenia. We report on a male infant who presented with anaemia and neutropenia and showed signs of developmental delay after dietary restriction for food allergy and eating difficulties and zinc therapy administered for the treatment of atopic dermatitis at a dose nine times the daily dietary allowance for his age group. After 1 mo of zinc withdrawal, copper and ceruloplasmin concentrations had increased, and the blood cell count had improved, activity was increasing but verbal development remained limited. As development improved after withdrawal of zinc, we cannot rule out a relation between developmental delay and hyperzincaemia and/or hypocupraemia.

Conclusion: Caution must be exercised in administering zinc to children during their neurological development.
Natural history of the cerebrovascular complications of Fabry disease
Authors: Mehta A , Ginsberg L
Published: August 2010

Fabry disease is a rare, X‐linked lysosomal storage disease caused by an inborn deficiency of α‐galactosidase A, which results in progressive accumulation of globotriaosylceramide in a range of cells and tissues. Neurological symptoms of Fabry disease, including peripheral neuropathy and cerebrovascular events, are among the most significant clinical aspects. In this paper we present the natural history and mechanisms involved in the cerebrovascular complications of Fabry disease using data reported in FOS – the Fabry Outcome Survey – and other registries and clinical studies. We discuss ways in which these manifestations can be modified by intervention, including both general measures for cerebrovascular disease and enzyme replacement therapy.

Conclusion: Data from FOS have provided important insights into the natural history of the cerebrovascular complications of Fabry disease. Furthermore, the database has demonstrated that significant renal or cardiac disease often co‐exists with cerebrovascular disease, and may predispose patients with Fabry disease to neurological disability and stroke.
Increase of faecal bifidobacteria due to dietary oligosaccharides induces a reduction of clinically relevant pathogen germs in the faeces of formula‐fed preterm infants
Authors: Knol Jan , Boehm Günther , Lidestri Maura , Negretti Franco , Jelinek Jürgen , Agosti Massimo , Stahl Bernd , Marini Antonio , Mosca Fabio
Published: August 2010

In a previous study on formula‐fed preterm infants, we were able to demonstrate that dietary oligosaccharides (a mixture of 90% galacto‐oligosaccharides and 10% fructo‐oligosaccharides in a concentration of 1 g/dl) stimulate the growth of faecal bifidobacteria. In the present explorative analysis of this study, we focus on the effect of the dominance of bifidobacteria on the presence of clinically relevant pathogens (Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticus, Pseudomonas aeruginosa, Enterobacter, Klebsiella, Proteus, Streptococcus group B, Clostridium difficile, Bacillus subtilis and Acinetobacter).

Conclusion: The data demonstrate that stimulation of bifidobacteria by prebiotic oligosaccharides reduces the presence of clinically relevant pathogens in the faecal flora, indicating that prebiotic substances might have the capacity to protect against enteral infections.
Calcium and phosphorus nutrition in preterm infants
Authors: Demarini Sergio
Published: August 2010

Metabolic bone disease is a common event in preterm infants. Between 24 wk gestation and term, the fetus accrues approximately 80% of body Ca, P and Mg. Consequently, preterm infants miss in part or completely the period of greatest mineral accretion. Ca and P requirements in preterm infants are based on demands for matching intrauterine bone mineral accretion rates and on maintenance of normal serum Ca and P concentrations. Daily physical therapy may be a useful adjunct, as it is associated with a significant increase in bone mineral density and content. Osteopenia/rickets of prematurity seems to be a self‐resolving disease. However, this does not imply that a period of demineralization is acceptable. While the potential long‐term consequences on peak bone mass are unclear at the moment, the short‐term benefits include the avoidance of fractures, less marked dolicocephaly and improved linear growth.
Neonatal necrotizing enterocolitis: An update
Authors: Neu Josef
Published: August 2010

Necrotizing enterocolitis (NEC) is a leading cause of mortality and morbidity in neonatal intensive care units. Here we review selected manifestations of NEC, risk factors involved in its pathophysiology as well as putative mechanisms associated with how an immature gut might be more susceptible to NEC. Treatment and potential preventive strategies are discussed.
What is the role of the prevention of allergy in the first period of life?
Authors: Agosti Massimo , Tandoi Francesco , Mosca Fabio
Published: August 2010

The widespread increase in the prevalence of allergic disease, which has occurred over the last 20 y, has created general concern in Europe and in the rest of the world. The reason for this increase is still partially unknown. In this period, despite a greater understanding of the pathogenesis and risk factors of allergies plus the greater efficacy of drugs to control the symptoms, the cost of intervention and the socio‐economic impact are still very high. For these reasons, prevention in the first period of life represents a goal for both developed and developing countries in order to reduce this upward trend.
Advances in the management of digestive problems during the first months of life
Authors: Savino Francesco , Maccario Stefano , Castagno Emanuele , Cresi Francesco , Cavallo Franco , Dalmasso Paola , Fanaro Silvia , Oggero Roberto , Silvestro Leandra
Published: August 2010

A study was carried out on 168 full‐term infants with digestive problems such as regurgitation and/or constipation to evaluate the efficacy of new infant formulas containing partially hydrolysed whey protein, modified vegetable oil with a high β‐palmitic acid content, prebiotic oligosaccharides and starch. Infants receiving the new formulas had an increase in stool frequency of 0.60 between day 1 and day 7 (95% CI 0.19–1.01;p=0.004) and 0.53 (95% CI 0.11–0.90;p=0.015) between day 7 and day 14. A reduction of 1.06 in the number of regurgitation episodes was reported between day 1 and day 7 (95% CI 0.24–1.88;p=0.012) and 1.31 (95% CI 0.42–2.21;p=0.005) between day 7 and day 14.

Conclusion:A prebiotic mixture of galacto‐/fructo‐oligosaccharides with a high β‐palmitic acid content may reduce digestive problems and improve intestinal tolerance in infants during the first months of life.
Randomized controlled trial of skin‐to‐skin contact from birth versus conventional incubator for physiological stabilization in 1200 g to 2199 g newborns
Authors: Kennell John H.
Published: August 2010

Publication of the report of Bergman et al. 1 should stimulate replications by others. If these investigators' findings are confirmed, and clear guidelines for the care of premature infants in the kangaroo method in the first 6 h and beyond are published, with particular attention to warm coverings for the babies' backs, this research could benefit large numbers of premature infants in the Third World.

Conclusion: As the authors indicate, skin‐to‐skin contact from the birth of premature infants may also be a good alternative in First World settings.
Quality of care of the preterm infant—the parent and nurse perspective
Authors: Jackson Karin , Ternestedt Britt‐Marie , Magnuson Anders , Schollin Jens
Published: August 2010

Aim: To study the subjective opinions about what is important in care at neonatal units and child health centres (CHCs) for premature newborns, and to compare these opinions with the care actually given. Subjects: 21 mothers, 20 fathers and 15 nurses at the neonatal unit, and 21 mothers, 14 fathers and 18 nurses at CHCs. Methods: A questionnaire on quality of Care from the Patient's Perspective was used. It contained three dimensions: identity‐oriented approach, medical‐technical competence and socio‐cultural atmosphere. Each dimension was evaluated in terms of subjective importance and perceived reality of given care. Results: In general, subjective importance was rated higher than perceived reality both for neonatal care and care at CHCs for the dimensions identity‐oriented approach and medical‐technical competence. However, higher ratings were given to neonatal care compared to CHCs for medical‐technical competence. High‐risk diagnoses and very low gestational age in the newborn did not affect the answers. Mothers rated medical‐technical competence higher than nurses for neonatal care. Mothers and nurses rated identity‐oriented approach higher than fathers for CHCs.

Conclusion: Although both neonatal care and care at CHCs were highly rated, improvements can be made to fulfil the expectations of parents and nurses. Neonatal units seem to be more efficient in taking care of the special needs of these newborns compared to CHCs. The need for an optimal identity‐oriented approach, medical‐technical competence and socio‐cultural atmosphere could strengthen the possibilities of parents to be confident in their parental role.
Bronchial responsiveness to methacholine and adenosine 5′‐monophosphate (AMP) in young children with post‐infectious bronchiolitis obliterans
Authors: Kyun Kim Do , Yoo Young , Yu Jinho , Choi Sun Hee , Koh Young Yull
Published: August 2010

Aim: Bronchial hyperresponsiveness (BHR) is a characteristic feature of asthma, but it is also frequently demonstrated by children and adults with chronic obstructive lung diseases. BHR is usually measured by bronchial challenges using direct or indirect stimuli. The aim of this study was to compare these two types of bronchial challenge in young children with post‐infectious bronchiolitis obliterans (BO). Methods: Methacholine and adenosine 5′‐monophosphate (AMP) bronchial challenges were performed on preschool children with post‐infectious BO (n=18), those with asthma (n=23) and in controls (n=20), using a modified auscultation method. The endpoint was defined as the appearance of wheezing and/or oxygen desaturation. Results: A positive response to methacholine (an endpoint concentration ≤8 mg/ml) was observed in 88.9% (16/18) of the patients with post‐infectious BO, but a positive response to AMP (an endpoint concentration ≤200 mg/ml) was observed in only 22.2% (4/18). All patients with asthma responded positively to methacholine, and most (21/23, 91.3%) of them also responded positively to AMP. The majority of the controls were insensitive to both challenges.

Conclusion: BHR to methacholine is a frequent, but by no means universal, finding in young children with post‐infectious BO, but is usually not accompanied by BHR to AMP.