bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of extremely premature newborns: a survey of attitudes among Danish physicians
Authors: Norup M
Published: August 2010

In order to describe the attitudes towards the treatment of extremely preterm infants, a questionnaire presenting a series of fictitious situations concerning imminent extremely preterm labour and treatment of an infant born after 24 weeks gestation was mailed to all physicians employed at obstetrical or paediatric departments in Denmark. The questionnaire was designed in two versions, differing as regards the parents' situation and attitude towards treatment. Each version was sent to half of the sample. Of 954 questionnaires 664 (69.6%) were completed and returned. Most respondents advocated active treatment prior to and immediately upon delivery, but many would withhold more intensive treatments or withdraw treatments in case of severe complications. The parents' situation and attitude towards treatment played a role in forming the decision choice to a significant proportion of the respondents. In severe cases, many would provide morphine in doses that could unintentionally hasten death, while few were in favour of legalizing active euthanasia.
The association of poor adherence and acute metabolic disorders with low levels of cohesion and adaptability in families with diabetic children
Authors: Tubiana‐Rufi N , Moret L , Czernichow P , Chwalow J ,   The PEDIAB Collaborative Group
Published: August 2010

A cross‐sectional multicentre study was conducted in 165 French diabetic children aged 7–13 y and their parents. A standardized scale (FACES III) was used to determine if family cohesion and adaptability (i) differed in diabetic children's families, as compared to other families; (ii) were related to an adherence measure; or (iii) were related to metabolic control. More diabetic families than comparison families fell into the categories of disengaged with low levels of cohesion, and rigid with low levels of adaptability. Scores of cohesion and adaptability were significantly and positively correlated with both children's and parents’adherence scores, but not with HbA1c levels. Children whose families were characterized as rigidly disengaged had a significantly greater number of hypoglycaemias and six times as many episodes of ketoacidosis than the other diabetic children. Not only in adolescents, but also in families of diabetic children, family‐centred interventions are needed to improve compliance and to prevent acute metabolic complications.
Wilms’tumour in infancy
Authors: Kullendorff C‐M , Wiebe T
Published: August 2010

During a 15‐y period, 48 children were treated for Wilms’tumour (WT). Seven of them were <1 y of age at diagnosis. One child presented with non‐traumatic haematuria, but in all the other children WT was revealed as a palpable abdominal mass at routine examination or investigation due to another disease. The four children under 6 months of age at diagnosis were primarily operated upon; the others received preoperative chemotherapy. Two children had chromosomal aberrations in the WT tumour specimen. The follow‐up revealed that postoperatively six children are healthy with no evidence of relapse from WT, but one child had a contralateral relapse successfully enucleated. The clinical behaviour and management of WT in infants differ compared with that in older children. The diagnosis may be uncertain and it can be difficult to distinguish between malignant and non‐malignant lesions. It is essential to realize the possibility of WT, even in children <1 y of age.
Morbidity and neurological function of very low birthweight infants from the newborn period to 4y of age. A prospective study from the south‐east region of Sweden
Authors: Bylund B , Cervin T , Finnström O , Gäddlin PO , Kernell A , Leijon I , Sandstedt P , Wärngård O
Published: August 2010

All 107 infants weighing ≤ 1500 g at birth (VLBW) and born alive in the south‐east region of Sweden during a 15‐month period in 1987–88 were enrolled in a prospective study to determine the prevalence of handicap and to assess neurological function in comparison with controls. Eighty‐six (80%) infants survived. Twenty (19%) had intracranial haemorrhages (ICH) assessed by ultrasound examinations in the neonatal period and 2 (2.3%) retinopathy of prematurity stage 3 or more. The VLBW infants who survived had fewer optimal neurological responses than the controls at 40 weeks post‐conceptional age. Eighty‐two VLBW children were followed to 4y of age. Three (4%) children had a neurological handicap and 9 (11%) had a moderate neurological deviation. Neither the size of ICH nor neonatal optimality score correlated to neurological outcome at 4 y of age. The VLBW children without neurological handicap or deviation (n= 70) had a delay in psychomotor development in comparison with the controls. Mental development and school performance, in particular language development, will be examined at school age.
Growth and body composition of preterm infants: influence of nutrient fortification of mother's milk in hospital and breastfeeding post‐hospital discharge
Authors: Wauben IPM , Atkinson SA , Shah JK , Paes B
Published: August 2010

We examined the influence of multi‐nutrient fortification of mother's milk (MM + MNF) compared to supplementation with calcium and phosphorus (MM + CaGP) alone in hospital (in a randomized trial), and of breastfeeding (post‐MM) compared to formula feeding (post‐FF) after hospital discharge with a descriptive analysis of growth and body composition to 1 y corrected age in preterm infants. Anthropometry, nutrient intakes and whole body bone mineral content, lean and fat mass were determined at four time points in the first year after term corrected age. Body composition was determined with dual energy X‐ray absorptiometry. MM + MNF compared to MM + CaGP for preterm infants in the early neonatal period did not appear to influence growth or body composition in the first year. Growth in post‐MM and post‐FF groups was within the normal range of growth references derived from term infants fed mother's milk. Post‐MM infants had lower whole body bone mineral content (132.3 ± 10.4 g) at 6 months corrected age when compared to post‐FF infants (159.4 ± 14.1 g) and greater percent fat mass to 12 months corrected age. These differences may result from the lower calcium, phosphorus and protein intakes in post‐MM compared to post‐FF infants. Our findings demonstrate that dietary practices after hospital discharge likely have a greater impact on body composition in prematurely born infants than dietary practices in hospital. Whether the observed differences in body composition between breastfed and formula‐fed preterm infants have any long‐term consequences requires further investigation.
Gallbladder volume and contractility in term and preterm neonates: normal values and clinical applications in ultrasonography
Authors: Ho M‐L , Chen J‐Y , Ling U‐P , Su P‐H
Published: August 2010

The aim of this study was to establish the normal values and evaluate associated factors of gallbladder volume and contractility in term and preterm neonates by using ultrasonography. Sonographic measurement of gallbladder volume was performed by using the ellipsoid method in 50 preterm and 46 term infants. We collected data soon after delivery and at 6‐h fasting, and at 3‐h and 6‐h fasting following regular milk feeding. Serial postprandial changes of gallbladder volume and contractility were collected at 15‐min intervals for one hour. Gallbladder contraction index (C.I.) was determined as percentage decrement of postprandial size from initial size. Fasting gallbladder volume was larger in term group (p < 0:05). Term neonates more readily showed significant contraction (C.I. > 50%;p < 0:05). In preterm infants significant contraction was clearly observed at postconceptional age > 31 weeks or body weight > 1300 g. The presence of hepatobiliary diseases might be detected by evaluating serial changes of gallbladder volume and contractility under ultrasonography in the neonatal stage.
Late death of very low birthweight infants
Authors: Fillmore EJ , Cartlidge PHT
Published: August 2010

The causes of 59 postneonatal deaths of very low birthweight infants were determined. Bronchopulmonary dysplasia (BPD) was the cause of 19 deaths. It also coexisted in 12/20 deaths from infection and 9/20 deaths from other causes. Improvement will be best achieved by advances in the prevention and treatment of BPD.
Dual energy X‐ray absorptiometry of the hand and wrist–a possible technique to assess skeletal maturation: methodology and data in normal youths
Authors: Braillon PM , Guibal AL , Pracros‐Deffrenne P , Serban A , Pracros JP , Chatelain P
Published: August 2010

Ninety five normal Caucasian subjects (51F, 44 M) aged from 2 to 25 y were measured at the hand and wrist level with a small DXA system (pDEXA™) in order to obtain the normal values of the bone mineral content (BMC), density (BMD) and projected area (A) of carpal (c) and metacarpal (m) bones. BMDc ranged from 0.065 ± 0.007 g/cm to 0.365 ± 0.035 g/cm in females and 0.425 ± 0.040 g/cm in males. It presented a sharp change of increase rate at 15.5 and 17 y of age in girls and boys, respectively. Ac presented the same kind of evolution as BMDc, but had a larger value dispersion. The second metacarpal bone had the highest BMCm value in 85% of females and 90% of males. The sum of BMCmi or Ami values (i = 1–5) and the projected mean density of the 5 metacarpal bones was well correlated with BMCc, Ac and BMDc, respectively (r> 0.90). A volumetric mineral density, dmi, calculated for each of these bones, approximated to a cylinder, was correlated with age (r > 0.85).
Open lung biopsy–successful diagnostic tool with therapeutic implication in the critically ill paediatric population
Authors: Steinberg R , Freud E , Ben‐Ari J , Schonfeld T , Golinsky D , Mor C , Zer M
Published: August 2010

Open lung biopsy (OLB) is an important diagnostic tool in children with immune deficiency and/or chronic lung disease with diffuse pulmonary compromise. These patients require a tailored therapeutic approach owing to their fragile status and the side effects of unnecessary or inadequate treatment. Twenty‐six patients of mean age 5.6 y underwent 41 open lung biopsies in our centre between 1991 and 1995. Seventeen (65%) were immunocompromised (including 13 with malignancy) and 9 had other lung diseases. The biopsies were diagnostic in 25 patients (96%), and complete clinical‐pathological correlation was found in 11 (42%). A specific infectious aetiology was detected in nine patients (35%), all of them immunocompromised. Therapeutic changes were instituted on the basis of the biopsy findings in 18 patients (69%). Two patients had postoperative complications (prolonged pleural leak). We conclude that OLB is a safe diagnostic procedure even in the critically ill child and should be employed without hesitation when conventional methods fail to provide a definitive diagnosis to help redirect therapy.
”Idiopathic neutropenia’in very low birthweight infants
Authors: Juul SE , Calhoun DA , Christensen RD
Published: August 2010

We employed a standardized investigative approach to evaluate four cases of“idiopathic neutropenia”in very low birthweight infants. The evaluation included maternal anti‐neutrophil antibodies, a marrow aspiration, and a three‐day trial of recombinant granulocyte colony‐stimulating factor (rG‐CSF). All patients had neutropenia at or shortly following delivery, and remained neutropenic (generally <500//μl) for 1‐9 weeks until rG‐CSF was administered. Blood and bone marrow studies in all 4 indicated that the neutropenia was: (i) the kinetic result of diminished neutrophil production; (ii) not alloimmune; (iii) not cyclic; and (iv) not associated with recognized inborn errors, bacterial or viral infections, or medications. All responded to rG‐CSF by transiently increasing their blood neutrophils to normal, and the neutropenia resolved in all cases with time. It is likely that“idiopathic neutropenia”in this population represents a common phenotype of several different causes, rather than a single entity. Some cases, perhaps the majority, will respond to a short course of rG‐CSF administration.
Changes in day care attendance rates and in the occurrence of adenoidectomies and tympanostomies
Authors: Niemelä M , Uhari M , Luotonen M , Luotonen J , Manninen M‐P , Puhakka H
Published: August 2010

The care of a child in a day care center is a marked risk factor for acute otitis media. In a nationwide questionnaire survey we found that the rate of tympanostomies and adenoidectomies was 59–67% higher for the children cared for at a day care center before the age of 3 y. When the local authorities in Finland at the beginning of 1990 were obliged by law to arrange day care for all children under 3y, the number of adenoidectomies performed on children at this age increased by 30%.
Interferon‐alpha in viral and bacterial gastroenteritis: a comparison with C‐reactive protein and interleukin‐6
Authors: Mangiarotti P , Moulin F , Palmer P , Ravilly S , Raymond J , Gendrel D
Published: August 2010

Mangiarotti P, Moulin F, Palmer P, Ravilly S, Raymond J, Gendrel D. Interferon‐alpha in viral and bacterial gastroenteritis: a comparison with C‐reactive protein and interleukin‐6. Acta Pædiatr 1999; 88: 592‐4. Stockholm. ISSN 0803‐5253

The aim of the study was to identify serum markers able to differentiate bacterial and viral origin in acute diarrhoea. Interferon‐alpha (INF‐α), C‐reactive protein (CRP) and interleukin‐6 were determined on admission in the sera of 119 children aged between 1 mo and 14 y who were hospitalized for rotavirus (n = 60) or bacterial diarrhoea (Salmonella spp. 39 cases, Shigella spp. 15 cases, Campylobacter jejuni 5 cases). CRP concentration was >10mg/l in 48.3% of children with viral gastroenteritis and 86.4% of children with bacterial gastroenteritis. IL6 concentration was >100pg/ml in 11.7% and 26.3% of cases, respectively. INF‐α was detected in 79.1% of children with rotavirus (sens 79%) and in 3.5% (spec 93%) with bacterial gastroenteritis. However the INF‐α assay takes 48 h and pathogens are often identified from stools before interferon results are available. We found that serum markers are not discriminating enough to differentiate between viral and bacterial gastroenteritis in emergency cases. □C‐reactive protein, interferon‐alpha, interleukin‐6, viral gastroenteritis, bacterial gastroenteritis
Clinically symptomatic central venous catheter‐related deep venous thrombosis in newborns
Authors: Salonvaara M , Riikonen P , Kekomäki R , Heinonen K
Published: August 2010

Salonvaara M, Riikonen P, Kekomäki R, Heinonen K. Clinically symptomatic central venous catheter‐related deep venous thrombosis in newborns. Acta Pædiatr 1999; 88: 642‐6. Stockholm. ISSN 0803‐5253

The objective of this study was to evaluate the incidence of clinically symptomatic central venous catheter (CVC)‐related deep venous thrombosis (DVT) in newborns and small infants and to try to identify clinical and genetic risk factors for catheter‐related DVT among children with thrombotic complications. CVC was inserted in 44 consecutive infants (age range 0‐90 d) during the period January 1990 to December 1995 in the neonatal intensive care unit (NICU) of Kuopio University Hospital in Kuopio. The symptoms of DVT were: syndrome of superior vena cava in 2, swelling at the CVC puncture site in 6 and repeated CVC obstructions in 2. The formation of DVT was verified by venography. Children with DVT (n= 10) had 26 (10‐365, in total 623) catheter days compared with 9 d (1‐155, in total 591) in patients without DVT (n = 26) (p < 0.005). The median (range) number of days from catheter insertion to diagnosis of DVT was 19 (7‐210). CVC had to be removed from 11 (25%) children due to various complications. There was no DVT‐related mortality. A positive family history with thromboembolic episodes at a young age was found in 3 of 10 families with a child suffering CVC‐related DVT. The levels of coagulation inhibitors were evaluated at the age of 9‐69 mo in all 10 (23%) children with CVC‐related DVT. We detected no deficiencies in protein S, protein C or antithrombin III. One child was heterozygous for the point mutation (R506Q) in the factor V gene known to cause activated protein C resistance (APCR). We conclude that newborns with CVC are at great risk of DVT and that the aetiology of DVT can rarely be identified via measurements of coagulation inhibitors. □Antithrombin III, central venous catheter, children, factor Vgene mutation, protein C, protein S, thrombosis
Evaluation of interleukin‐6, tumour necrosis factor‐α and interleukin‐1β for early diagnosis of neonatal sepsis
Authors: Silveira RC , Procianoy RS
Published: August 2010

Silveira RC, Procianoy RS. Evaluation of interleukin‐6, tumour necrosis factor‐α and interleukin‐1β for early diagnosis of neonatal sepsis. Acta Pædiatr 1999; 88: 647‐50. Stockholm. ISSN 0803‐5253

The objective of this study was to assess the contribution of interleukin‐6 (IL‐6), tumour necrosis factor‐α (TNF‐α) and interleukin‐1β (IL‐1β) to an early diagnosis of early‐onset neonatal sepsis. A cohort of 117 newborn infants delivered during a 1‐y period had IL‐6, TNF‐α and IL‐1β, blood and cerebrospinal fluid (CSF) cultures, leucocyte and platelet count collected on the initial evaluation of possible early‐onset sepsis. They were divided into four groups: I, positive blood and/or CSF cultures; II, probably infected with clinical sepsis but negative cultures; III, same as group II but mother received antibiotic antepartum; and IV, newborn infants that did not receive any antibiotic therapy. There were no differences among the four groups with respect to mean gestational ages and birthweights, median Apgar scores, type of delivery, or number of newborn infants with leucocyte count <5000mm−3 or >25 000 mm−3, platelet count <100 000mm−3, immature/total neutrophil ratio >0.2, absolute neutrophil count <1000mm−3 and median IL‐1β levels. Median IL‐6 and TNF‐α levels were significantly higher in groups with patients with a diagnosis of clinical sepsis than in controls. The optimal cut‐off point was 32 pg ml−1 for IL‐6 and 12pgml−1 for TNF‐a. The combination of both provided a sensitivity of 98.5%. In conclusion, the combination of IL‐6 and TNF‐α is a highly sensitive marker of sepsis in the immediate postnatal period. □Cytokine, infection, newborn infant
Partial trisomy 13q22→qter and monosomy 18q21→qter as a result of familial translocation
Authors: Čekada S , Kilvain S , Brajenović‐Milić B , Brečević L , Kirinčić‐Paučić E , Franulović J
Published: August 2010

Čekada S, Kilvain S, Brajenović‐Milić B, BreČević L, KirinČić‐PauČić E, Franulović J. Partial trisomy 13q22→qter and monosomy 18q21→qter as a result of familial translocation. Acta Pædiatr 1999; 88: 675‐8. Stockholm. ISSN 0803‐5253

We report on a patient with a partial trisomy of chromosome 13q22→qter and partial monosomy of chromosome 18q21→qter showing distinct malformations. The phenotype of this unbalanced karyotype has not been previously described. The proband had a craniofacial dysmorphism, neck pterygium, closed fists with overlapping fingers, cutaneous appendix of the left fist, equinovarus and postaxial hexadactyly of the feet, atrial septum defect, unilateral cryptorchidism and hypertrophic pyloric stenosis. Using fluorescence in situ hybridization (FISH) the father's karyotype 46,XY.ish t(13;18)(13pter→13q22::18q21→18qter; 18pter→18q21::13q22→13qter) and the child's 46,XY.ish der(18)(18pter→18q21::13q22→13qter)pat were established. The mother's karyotype was normal. A risk of unbalanced offspring in carriers of a balanced reciprocal translocation depends on the length and genetic constitution of the exchanged segments. Risk figures should come only from empirical data. A phenotypically normal child with a balanced or normal karyotype could be born in the case of alternate segregation. Amniocentesis should therefore be recommended in any further pregnancy. □FISH, karyotype, malformations, prenatal diagnosis
Plasma metabolites after a lipid load in infants with congenital heart disease
Authors: Lundell K‐H , Sabel K‐G , Eriksson BO
Published: August 2010

Growth retardation is common in infants with congenital heart defects. The aim of this study was to investigate whether growth retardation or type of heart defect in infants with congenital heart defects is related to disturbances in lipid metabolism. Sixteen infants with ventricular septal defects and six infants with transposition of the great arteries were given an intravenous load of lipid emulsion (Intralipid® 20mg/ml) corresponding to 0.5 g fat/kg body weight for 5 min after fasting for 8h. Blood samples were drawn immediately before the infusion and 3, 20, 60, 120 and 240 min after the infusion was completed. Plasma concentrations of triglycerides (TG), free fatty acids (FFA), ketones, lactate, pyruvate, alanine, glycerol and glucose were determined. The fatty acid patterns in the TG and FFA fractions were measured using gas chromatography. Severe growth retardation in infants with defects of these kinds was correlated to higher fasting and maximum levels of linoleic acid in plasma FFA. The maximum levels of linoleic acid in the TG fraction were positively correlated to weight SD score, and maximum glycerol levels were higher in the most growth‐retarded infants, indicating faster intravascular lipolysis. Linoleic acid in the TG fraction was still elevated at 120 and 240 min after the lipid load. Some differences between the cyanotic and VSD groups could be noted. These indicate decreased metabolic capacity to utilize released FFA in the cyanotic group. Infants with cyanotic heart defects also had higher lactate and alanine levels compared to infants with VSD. Our results support the hypothesis that lipid metabolism is disturbed in infants with congenital heart defects. □Congenital heart defect, free fatty acids, linoleic acid, lipids, lipolysis, metabolism, triglyceride
Beneficial effects of dietary supplementation in a disorder with defective synthesis of cholesterol. A case report of a girl with Smith‐Lemli‐Opitz syndrome, polyneuropathy and precocious puberty
Authors: Starck L , Björkhem I , Ritzén EM , Nilsson BY , von Döbeln U
Published: August 2010

In 1993 the Smith‐Lemli‐Opitz (SLO) syndrome, known as a malformation syndrome characterized by certain stigma, turned out to be a metabolic disease with a defect in the last step of cholesterol biosynthesis. This led to the possibility of identifying affected individuals by biochemical methods and of increasing understanding of pathogenic mechanisms. Hopes of influencing the effects of the metabolic defect by dietary supplementation were raised and reports with some benefits of treatment have been published. This is a report of a 12‐y‐old girl with the SLO syndrome in an apparently progressive form. In addition to typical signs and well‐known symptoms she has a verified polyneuropathy and precocious puberty. She has been treated with cholesterol and bile acids for 3 y, during which time the progressive course has been arrested. A notable effect has been the improvement of her polyneuropathy, verified by measurement of nerve conduction velocities. Possible mechanisms involved in the pathogenesis of her precocious puberty are discussed. □Cholesterol, cholesterol and bile acid treatment, polyneuropathy, precocious puberty, Smith‐Lemli‐Opitz syndrome
Depth of sleep and sleep habits among enuretic and incontinent children
Authors: Néveus T , Hetta J , Cnattingius S , Tuvemo T , Läckgren G , Olsson U , Stenberg A
Published: August 2010

In order to evaluate differences in sleep factors between children with wetting problems and dry children, questionnaire data were obtained from 1,413 schoolchildren between the ages of 6 and 10 y. The analyses were performed using logistic regression, and adjusted odds ratios (ORs) were calculated to approximate the relative risk. Current enuresis was associated with a subjectively high arousal threshold, pavor nocturnus, nocturia and confusion when awoken from sleep (ORs 2.7, 2.4, 2.1 and 3.4, respectively), whereas children with current incontinence often experienced bedtime fears, onset insomnia or nocturia (ORs 2.4, 2.3 and 2.7, respectively). Children exhibiting urinary urgency were overrepresented among both children with current enuresis (OR 2.5) and those with current incontinence (OR 17.2). It is concluded that impaired arousal mechanisms and bladder instability are aetiological factors underlying nocturnal enuresis. □Arousal, enuresis, incontinence, sleep
Utilization of supplemental iron by premature infants fed fortified human milk*
Authors: Moody GJ , Schanler RJ , Abrams SA
Published: August 2010

We measured red blood cell iron incorporation (RBC‐inc) in 13 human milk‐fed premature infants (birthweight 1037 ± 289 g, gestational age 27 ± 2 wk, weight at start of study 1571 ± 426 g) who were receiving full tube‐feedings of human milk fortified with a commercial human milk fortifier (FortHM). The relative RBC‐inc of supplemental iron (2 mg/kg/d of ferrous sulfate) was assessed using 57Fe sulfate mixed directly into a 24‐h volume of FortHM, and 54Fe sulfate given as a bolus between two FortHM feedings the next day. RBC‐inc was similar between the two methods of supplemental iron administration (4.7 ± 2.5% vs 4.6 ± 1.5%, respectively). Although these values are lower than RBC‐inc expected from iron native to human milk, the relatively large amount of iron in the supplements contributed most of the iron incorporated into RBC by the infants. There was a significant positive correlation between the reticulocyte count and RBC‐inc. As the high nutrient (especially calcium) content of the FortHM did not interfere with iron utilization, adding iron directly to FortHM, or incorporating it into commercial fortifiers, may be a practical method to provide iron to premature infants. □Human milk, iron absorption, premature infants, stable isotopes
Intensified phototherapy using daylight fluorescent lamps
Authors: De Carvalho M , De Carvalho D , Trzmielina S , Lopes JMA , Hansen TWR
Published: August 2010

Jaundice is a common reason for therapeutic intervention in newborn infants and phototherapy is effective treatment if enough light energy is delivered to a skin surface area of sufficient size. Narrow spectrum blue light is superior to white light, but in developing countries fluorescent blue lamps often have to be imported and are much more expensive than white lamps. We developed a phototherapy unit in which seven daylight fluorescent tubes are placed immediately under the floor of a transparent plexiglass crib. The efficacy of this unit, delivering ?19 μW/cm2/nm, was compared with that of two conventional phototherapy units using overhead lamps placed 35 cm above the infants. One unit used daylight fluorescent tubes and delivered ?4 μW/cm2/nm, the other unit used special blue fluorescent tubes and delivered ?22 μW/cm2/nm. Fifty‐one infants were included in the analyses, all of them breastfed on demand. Serum bilirubin levels were determined spectrophotometrically at 0, 12 and 24 h. The decrement in serum bilirubin concentrations was significantly greater in infants undergoing phototherapy with the new device or with special blue lamps compared to conventional overhead daylight lamps (p < 0.001 both at 12 and at 24 h). We conclude that highly efficient phototherapy may be delivered with daylight fluorescent lamps placed in very close proximity to the patient. Thus, lack of access to expensive imported special blue lamps does not preclude delivery of effective phototherapy in developing countries. □Neonatal jaundice, phototherapy, wavelength
Successful treatment of intrathecal methotrexate overdose with folinic acid rescue: a case report
Authors: Riva L , Conter V , Rizzari C , Jankovic M , Sala A , Milani M
Published: August 2010

A 7‐y‐old boy with acute lymphoblastic leukaemia (ALL) received 600 mg of i.v. methotrexate (MTX) over 2 h, followed by triple intrathecal therapy (TIT) with cytosine arabinoside 30 mg, methylprednisolone 10mg and MTX 300 mg (instead of the prescribed 12 mg). Ninety minutes later the patient developed headache, loss of consciousness and generalized hypertonia. He was transferred to the Intensive Care Unit, intubated and treated with phenobarbital. Three hours after the TIT, the levogyrus form of folinic acid (equivalent to double doses of the racemic product) was started i.v. at a dose of 100 mg every 3h for 24 h, and every 6 h in the following 24 h. Cerebrospinal fluid was examined and was found normal. The patient subsequently remained in normal neurological status. The favourable outcome in our case suggests that folinic acid rescue may be adequate to prevent sequelae in patients who undergo intrathecal MTX overdoses up to 300 mg. □Childhood acute lymphoblastic leukaemia, folinic acid rescue, intrathecal methotrexate overdose
Impact factor and the future of Acta Pædiatrica and other European medical journals
Authors: Zetterström R
Published: August 2010

Most European medical journals attain very low impact factors, as reported in Journal Citation Reports, and from the European point of view the depressing outlook is continually falling values. Among many reasons behind the low impact factor of European journals is citation bias as a consequence of the low prestige of European journals. In the case of Acta Pædiatrica, which has published between 4 and 15 supplements annually during the period 1994—98, the low impact factor of the articles included in these supplements reduces the overall impact factor to less than half of what it would be had no supplements been published, i.e. from 1.88 to 0.81. It is obvious that by refusing to publish supplements the impact factor of Acta Pædiatrica would be dramatically elevated. Some of the supplements, such as the one on persistent diarrhoeal disease which had to be reprinted as the original edition was sold out (1), are undoubtedly of great educational value and have an important role as sources of references. However, it is difficult for Acta Pædiatrica to continue to publish supplements because of the load imposed on the impact factor of the journal.

It is suggested that a scientific committee within the European Union seriously considers the importance of supporting European Biomedical Science, and that one way of doing so is to improve the prestige and quality of European journals. □Acta Paediatrica, European journals, impact factor, supplements
Anaemia and iron deficiency screening in adolescence: a pilot study of iron stores and haemoglobin response to iron treatment in a population of 14—15‐year‐olds in Norway
Authors: Eskeland B , Hunskaar S
Published: August 2010

Screening for haemoglobin (Hb) and s‐ferritin, in 176 of all 189 (93%) pupils at 8th grade (14—15‐years‐old) in one Norwegian community was performed in order to map the prevalence of anaemia and depleted iron stores. In order to determine the clinical significance of the findings, a questionnaire aimed at detecting symptoms or risk factors for iron deficiency was completed by all participants, and a 3 mo therapeutic trial with iron was offered to subjects with s‐ferritin values below 15 p.g/l. Four percent of girls and 8% of boys were anaemic according to WHO cut‐off levels. S‐ferritin < 15 p.g/l was found in 25% of girls and 30% of boys. Forty‐four of 48 pupils with s‐ferritin < 15 p.g/l completed the therapeutic trial. Only three pupils had a clinically significant increase in Hb, representing less than 2% of the population. The questionnaire gave no clues that could identify subjects with depleted iron stores. To increase Hb in one 14—15‐y‐old with depleted iron stores, 59 (95% CHI: 20—285) had to be screened and 16 (6—76) had to be given iron treatment. This pilot study suggests that functional iron deficiency is rare in Norwegian adolescents despite a high frequency of low iron stores. A double blind, placebo controlled study covering the entire span of pubescence is needed to confirm these results. □Adolescence, anaemia, iron deficiency, ferritin, haemoglobin, screening, therapeutic trial
Mucoid presentation of acute enterocolitis in children: a hospital‐based case‐control study
Authors: Dutta P , Mitra U , Saha DR , Niyogi SK , Manna B , Bhattacharya SK
Published: August 2010

A hospital‐based case‐control study was carried out to clarify the characteristics of mucoid presentation of acute enterocolitis in children. One hundred sixty‐eight cases of acute mucoid enterocolitis (study population) were compared with 200 cases of watery diarrhoea and 118 cases of blood dysentery (control groups) on the basis of clinical characteristics and findings on stool examination. Study and control groups were comparable with respect to age, body weight and nutritional status. There was no significant difference in clinical characteristics (duration of diarrhoea, stool frequency, presence of vomiting, fever and dehydration) between patients suffering from mucoid enterocolitis and blood dysentery. However, watery diarrhoea patients had significantly high frequencies of vomiting (p = 0.00001) and dehydration (p = 0.00001). High numbers of microscopic red blood cells (mean±SD: 40.8 ± 16.8) and white blood cells (40.6 ± 18.0) were present in faecal samples of the patients with mucoid enterocolitis, which is indicative of infection caused by enteroinvasive enteropathogens. Shigella was a commonly identified enteropathogen in patients with mucoid enterocolitis (40.5%) and in patients with dysentery (46.6%), with no statistically significant difference (p= 0.30). Isolation of Salmonella was statistically similar in study and control groups. However, Entamoeba histolytica was detected in significantly high frequency in patients with mucoid enterocolitis as compared to the patients with dysentery (p = 0.0004) and watery diarrhoea (p = 0.00004). Our results indicate that mucoid enterocolitis patients are infected with enteroinvasive enteropathogens, and that stool examination is useful in establishing the aetiological diagnosis. □Acute enterocolitis, diarrhoea, dysentery, Entamoeba histolytica, faecal red and white blood cells, mucoid presentation, Shigella, Salmonella
Prognostic characteristics of asthma diagnosis in early childhood in clinical practice
Authors: Wever‐Hess J , Kouwenberg JM , Duiverman EJ , Hermans J , Wever AMJ
Published: August 2010

A registration study from clinical practice was set up to assess the prognostic value of symptoms and laboratory data at first visit for doctor‐diagnosed‘asthma’in early childhood. A total of 419 children aged 0—4 y, who were newly referred to the outpatient department of the Juliana Children's Hospital with possible asthma were enrolled over a 2‐y period. Data from history taking, physical examination, laboratory tests for atopic status at first visit and data from follow‐up visits were recorded. Two years after the first visit all medical records were reviewed for diagnostic label. The age groups 0—1 y and 2—4 y were analysed separately, because respiratory symptoms are often transient and sensitization to inhalant allergens is uncommon before the age of 2 y. The clinical diagnosis‘asthma’was made in 113 of 231 (49%) children aged 0—1 y and in 144 of 188 (77%) children aged 2—4 y. Characteristics from history taking indicated shortness of breath was the most prognostic symptom in both age groups. Eczema, wheeze and non‐allergic provoking factors (weather conditions) were further predisposing factors in the 0—1 y group, as were allergic provoking factors (inhalant allergens) and absence of ear‐nose‐throat‐history in the 2—4 y group. Adding laboratory data to history total serum IgE had prognostic value, but specific serum IgE against inhalant allergens (Phadiatop®) was a strong predisposing factor, especially in the 2—4 y group. These prognostic characteristics may enhance early recognition of asthma in infants and improve asthma care in clinical practice. □Asthma, characteristics, childhood, diagnosis, diagnostic index, prognostic value, sensitisation, symptoms
Ciliary motility at light microscopy: a screening technique for ciliary defects?
Authors: Santamaria F , de Santi MM , Grillo G , Sarnelli P , Caterino M , Greco L
Published: August 2010

To verify whether or not ciliary motility can be reliably assessed by light microscopy alone, we examined the nasal brushings of 53 patients with suspected ciliary dyskinesia and 10 healthy controls. The results of light microscopy were compared with cilia ultrastructure assessed with electron microscopy. Ciliary motility was significantly related with cilia ultrastructure. However, eight cases of lung disease due to bronchiectasis of unknown origin had immotile cilia on light microscopy, but normal ciliary ultrastructure on electron microscopy. Instances of normal and abnormal ultrastructure were detected in one case with motile cilia. There was an 83% agreement between electron microscopy and light microscopy. Sensitivity and specificity of light microscopy were 92% and 80%, respectively. In conclusion, light microscopy evaluation of ciliary motility does not appear to be a reliable screening test for ciliary dyskinesia because it does not quantify ciliary beat activity, which is a criterion for deranged ciliary motion. A complete evaluation of ciliary ultrastructure together with in vivo, if applicable, or in vitro function test (namely, the analysis of ciliary beat frequencies and/or waveform) is required for a definite diagnosis of ciliary dyskinesia. □Ciliary dyskinesia, ciliary motility, ciliary ultrastructure
Contribution of interleukin‐6 in distinguishing between mild respiratory disease and neonatal sepsis in the newborn infant
Authors: Källman J , Ekholm L , Eriksson M , Malmstrom B , Schollin J
Published: August 2010

The purpose of this study was to investigate if early samples of interleukin‐6 (IL‐6) could distinguish early bacterial sepsis from respiratory diseases in the newborn. IL‐6 and C‐reactive protein (CRP) were measured at onset of symptoms in newborns evaluated for sepsis during the first week of life. Five groups of children were investigated: proven sepsis, clinical sepsis, respiratory distress syndrome (RDS), transient tachypnoea of the newborn (TTN) and controls. IL‐6 was also analysed at the time when CRP was at its maximum level. The results showed that initial IL‐6 distinguished proven and clinical sepsis from TTN, but not from RDS. Initial CRP was of no value for diagnosis. Our conclusion is that early IL‐6 makes it possible to avoid antibiotics in children with TTN and contributes to the diagnosis of sepsis faster than CRP. □C‐reactive protein, interleukin‐6, neonatal septicaemia, respiratory diseases
Heart rate variability in the neonate and infant: analytical methods, physiological and clinical observations
Authors: Rosenstock EG , Cassuto Y , Zmora E
Published: August 2010

Naturally occurring oscillations in heart rate have long been considered to reflect the modulating influences of the autonomic nervous system. Individual reports of heart rate variability in healthy and sick neonates and infants have provided valuable information as to pathophysiological changes in autonomic cardiovascular control. It is evident that prematurity and poor health are reflected in attenuated heart rate variability. However, at present, there are few standard criteria for the analysis of heart rate variability, preventing precise comparisons among the various studies. Until recommendations for standardized analytical methods are made, clinical application of heart rate variability in neonatal and infant prognosis and therapy remains premature. □Heart rate variability, infant, maturation, neonate, power spectrum analysis, respiratory distress, sleep state, sudden infant death syndrome
Maternal predictors of early breast milk output
Authors: Ingram JC , Woolridge MW , Greenwood RJ , McGrath L
Published: August 2010

Previous attempts to show a quantitative relationship between maternal hormone levels and early milk output have used small sample sizes and simple correlations. Women of mixed parity and similar socio‐economic status and education were recruited to a study using multivariate analysis to look for these associations. Hormone levels (oestradiol, progesterone, prolactin and thyrotropin (TSH)) were determined for 91 mothers at four time points (ante‐ and postnatally) from finger‐prick blood spots by fluoro‐immunoassay. Milk output at 1 and 4 weeks was determined from 24‐h test weighings. Parity was found to be the most significant factor affecting breast milk volume at 1 wk postpartum (multiparous women delivered 142 ml more milk in 24 h than primiparous women). Total time spent feeding had a strong association with breast milk volume, with increasing time having a negative effect. Multiple regression analysis, controlling for parity and time spent feeding, showed a positive association of milk output at 1 wk with antenatal progesterone and antenatal prolactin levels. At 4 wk, higher postpartum oestradiol levels had a negative association and antenatal progesterone levels a positive association with milk output. This study demonstrates that there are quantitative associations between antenatal maternal hormone levels and breast milk output in the early postnatal period. □Breast milk output, oestradiol, parity, progesterone, prolactin
Plasma lipids, phospholipid fatty acids and indices of glycaemia in 10‐year‐old children born as small‐for‐gestational‐age or preterm infants
Authors: Decsi T , Erhardt É , Márkus A , Burus I , Molnár D
Published: August 2010

Low birthweight has been epidemiologically associated with unfavourable plasma lipid profiles and enhanced risk of cardiovascular morbidity in adulthood. Plasma lipids, lipoprotein cholesterols, apolipoproteins, fatty acid composition of plasma phospholipids and basic indices of glycaemia were investigated in 10‐y‐old children born with similarly low birthweights as small‐for‐gestational‐age (SGA; n = 16) or preterm infants (n = 16). Plasma total cholesterol (4.32 ± 0.57 vs 4.60 ± 0.52, mmol l_1, mean ± SD, SGA vs preterm subjects), low‐density lipoprotein cholesterol (2.54 ± 0.51 vs 2. 65 ± 0.51) and high‐density lipoprotein cholesterol (1.61 ± 0.25 vs 1.76 ± 0.18) concentrations did not differ between the 2 groups. There was no difference in plasma tri‐acylglycerol, apolipoprotein A‐I and B, insulin and glucose concentrations or phospholipid fatty acid values. There was no correlation between indices of lipid and carbohydrate metabolism. In conclusion, plasma lipid profiles and basic indices of glycaemia are not different in 10‐y‐old children born with similarly low birthweights as SGA or preterm infants. □Apolipoprotein, cholesterol, insulin, lipoprotein cholesterol, low birthweight, phospholipid fatty acid, 10‐y‐old children
Human astrovirus‐associated gastroenteritis in children under 2 years of age followed prospectively during a rotavirus vaccine trial
Authors: Pang X‐L , Vesikari T
Published: August 2010

This study evaluated the clinical significance of human astrovirus‐associated gastroenteritis in young children in the community. Placebo‐ (n = 1207) and rhesus rotavirus tetravalent (RRV‐TV) vaccine‐ (n= 1191) recipient children were followed from 2 mo to 2 y of age. Stool specimens from 1528 episodes of acute gastroenteritis (805 in the placebo group and 723 in the RRV‐TV vaccine group) were tested for astrovirus with a sensitive reverse transcription‐polymerase chain reaction (RT‐PCR) assay and positive results were confirmed by Southern hybridization using probes specific for astrovirus serotypes 1 and 2. Astroviruses were detected in 144 (9%) episodes of gastroenteritis; 92% of the findings were serotype 1 and 6% were serotype 2. The astrovirus peak season was in winter. Of the 102 children who had gastroenteritis with astrovirus as the only diarrhoea virus in the stools, 72% had watery diarrhoea, 59% had vomiting, 26% had fever, 5% needed oral rehydration and 3% were hospitalized. Overall, the clinical severity of astrovirus gastroenteritis was much lower than that of rotavirus gastroenteritis. RRV‐TV rotavirus vaccine did not protect against astrovirus gastroenteritis. It is concluded that astroviruses are common causative agents in acute gastroenteritis in young children, but the symptoms of astrovirus gastroenteritis are usually mild and the illness is therefore only of minor clinical significance. □Astrovirus, diarrhoea, gastroenteritis, rotavirus vaccine
Histamine provocation in young, awake children with bronchial asthma, using a fall in oxygenation as the only indicator of a bronchial reaction
Authors: Holmgren D , Redfors S , Wennergren G , Sten G
Published: August 2010

Bronchial provocation with histamine was performed in 11 boys and 6 girls, age range 2.7‐7.4 y, with unspecific respiratory symptoms or bronchial asthma, using a fall in oxygenation as the only indicator of a bronchial reaction. In addition to transcutaneous oxygen tension (tcPO2), transcutaneous carbon dioxide tension (tcPCO2) was continuously monitored during the provocation procedure in order to identify possible changes in ventilation. A fall of 20% or more in the tcPO2 below a “floating” baseline value, defined as the highest tcPO2 value between the inhalations of histamine up to that point, was regarded as indicating a significant bronchial reaction. One child was excluded from the study because of an “early, false‐positive” reaction due to hyperventilation during the inhalation, verified by a decrease in the tcPCO2 followed by a compensatory period of hypoventilation, resulting in a fall of more than 15% in the tcPO2 after the inhalation of saline. In the vast majority of the children, however, the tcPO2 values remained stable during the first dose stages of saline and histamine, with either a gradual fall immediately before or a distinct fall in conjunction with the reaction. The mean reaction concentration was significantly lower in the group of children with clinical asthma, 0.74 mg/ml, compared with the group of children with unspecific respiratory symptoms, 2.00 mg/ml (p = 0.03). In conclusion, a 20% fall in the tcPO2 can be used as the only indicator of a bronchial reaction during bronchial provocation tests in young, awake children. Changes in ventilation evaluated by monitoring tcPCO2, makes it possible to distinguish between a fall in oxygen tension due to an early, “false” reaction as a result of hypoventilation and a “true” bronchial reaction. □Asthma, bronchial provocation, oxygenation, young children
Continuous desferoxamine infusion by an infusor in thalassaemia major
Authors: Canatan D , Temimhan N , Dincer N , Özsancak A , Oľuz N , Temimhan M
Published: August 2010

Chelation therapy with desferoxamine (DFO) can be an important problem for patients with thalassaemia major (TM). In an effort to find a solution to this problem, a new delivery system based on a disposable and lightweight device was developed by Baxter. The aim of study was to investigate the compliance of patients and the effects and side effects of two different infusors. The 26 patients using infusors were divided into 2 groups, who were infused with DFO for 48 h (group A) and for 120h (group B). The 24‐h mean urinary iron and zinc excretion in groups A and B were statistically significant at the beginning and end of therapy (p < 0.001). Serum ferritin levels decreased in both groups compared with control (p < 0.001). No systemic reactions were observed either during or at the end of treatment. The compliance and use of infusors were 97% in group A and 72% in group B. In conclusion, better compliance was achieved and there were fewer local complications in group A than in group B. Subcutaneous infusion of DFO with both devices may be ideal for patients who have compliance problems and cannot be treated using portable pumps. The device is new and expensive, but excellent and effective for long‐term DFO infusion. □Desferrioxamine, infusor, thalassaemia