bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective Study of Acute Diarrhoea in Finnish Children from Birth to 2 1/2 Years of Age
Authors: RUUSKA TARJA , VESIKARI TIMO
Published: January 2008

ABSTRACT. To determine the incidence, clinical significance and etiology of acute diarrhoea in early childhood, a cohort of 336 children were followed from birth to the age of 24–32 (mean 26) months. More than half (55%) of the children had no diarrhoea, 26% had one episode and 19% had two or more episodes of diarrhoea during follow‐up; altogether 248 episodes of diarrhoea were detected. Rotavirus was by far the most common (26%) identified pathogen; adenoviruses were detected in 4 % and bacterial pathogens (EPEC, Salmonellae, Yersiniae) in 4% of the cases. Two thirds of the episodes remained etiologically unresolved. Rotavirus diarrhoea was significantly more severe than diarrhoea due to other causes; 75% of severe episodes of diarrhoea were associated with rotavirus. About two thirds of the infants were breast‐fed over 6 months; breast‐feeding for less than 6 months was associated with a higher incidence of rotavirus diarrhoea between 7–12 months of age but not thereafter. About three quarters of the children were cared for at home beyond 12 months of age; those at home had a lower rate of rotavirus diarrhoea than those at day‐care centers.
Quantitation of Muscles and Fat by Ultrasonography: A Useful Method in the Assessment of Malnutrition in Children
Authors: KOSKELO E.‐K. , KIVISAARI L. M. , SAARINEN U. M. , SIIMES M. A.
Published: January 2008

ABSTRACT. We used ultrasonography to measure muscles in the arms and thighs of 16 children with malignant diseases. Thicknesses of transverse sections of the brachial biceps muscle and the femoral quadriceps muscle were measured by ultrasound at the midpoint of the right arm and thigh. These two measures had a linear correlation (r=0.76). The ultrasound measurements did not differ from those obtained by the CT scan which was used as a reference standard. The reproducibility of the measurements was good, the coefficient of variation was 2.4% for the midarm muscles and 2.8% for the midthigh muscles. We conclude that the ultrasound method combined with simple anthropometric measurements is helpful in the assessment of nutritional status of children with potential malnutrition.
Oestrogen Treatment of Tall Girls: Effect Decreases with Age
Authors: IGNATIUS A. , LENKO H. L. , PERHEENTUPA J.
Published: January 2008

ABSTRACT. Fifty‐nine tall girls were treated with oestrogen to reduce final height, starting at the ages of 9.1 to 16.2 years. We assessed the result of this treatment by comparison with matched controls. The epiphyseal bone age at the start of therapy, the final height, the Bayley‐Pinneau (BP) and Roche‐Wainer‐Thissen (RWT) predictions of final height, and the errors in both predictions were evaluated. The matched pairs were divided into three groups according to bone age at the start of treatment; I < 10.5 (n= 16), II 10.5–12.0 (n= 22) and III > 12.0 years (n=21). The mean (SD) intrapair reduction of height for these groups was 9.7 (4.0) cm, 4.3 (4.3) cm and 3.5 (3.2) cm, respectively, according to BP predictions and 6.3 (4.3) cm, 3.4 (3.0) cm and 1.2 (3.3) cm according to RWT predictions. No method of predicting height is accurate for tall girls and simultaneous predictions may differ greatly. Close agreement between the BP and RWT predictions does not indicate greater accuracy. The earlier therapy is started, the greater is the effect. Young girls need psychosocial support with therapy.
An Update of the Swedish Reference Standards for Weight, Length and Head Circumference at Birth for Given Gestational Age (1977‐1981)
Authors: NIKLASSON A. , ERICSON A. , FRYER J. G. , KARLBERG J. , LAWRENCE C. , KARLBERG P.
Published: January 2008

ABSTRACT. An update of the Swedish reference standards for weight, length, and head circumference at birth, for each week of gestational age, is presented. It is based on the total Swedish cohorts of infants born 1977‐1981 (n= 475588). A “healthy population” (79%) was extracted, using prospectively collected data. Weekly (28‐42 weeks) grouped data for length and head circumference were well approximated by the normal distribution, but the distributions for birthweight were positively skewed. The original skewed distributions for birthweight were transformed, using the square root, resulting in distributions close to the Gaussian. For smoothing purposes, the weakly values for the mean and the standard deviation were both fitted by a third degree polynomial function. These functions also make possible the calculation of the continuous variable, standard deviation score, for individual newborn infants as well as a comparison of distributions between groups of infants. The reference values and charts presented here have two major advantages over the current Swedish ones: the sample size used is now sufficiently large at the lower gestational ages, so that empirically found variations can be used, and the skewness of the birth weight distribution has been taken into account. The use of the reference standards presented here improves and facilitates evaluation of sue deviation at birth.
Protein Energy Malnutrition: Problems and Priorities
Authors: WHARTON BRIAN
Published: January 2008

Protein energy malnutrition and infection are largely responsible for the very high postneonatal and toddler mortality ratios of developing countries. Availability of food is just one environmental factor in the aetiology of protein energy malnutrition—many others such as size at birth, infection and culture play a role. Diet needs as careful prescription as any other form of therapy, but in the severely malnourished child it is only one aspect of management; care is necessary to avoid or detect 6 complications: hypothermia, hypoglycaemia, encephalopathy, intractable diarrhoea, cardiac failure, and infection. Prevention should be incorporated within the child health services as a whole and delivered with them; however central government, and the food industry from farming to retailing, play an at least as important role as health care professionals.
Breast Feeding and the Older Infant
Authors: PRENTICE ANN
Published: January 2008

The possible benefits and disadvantages to the older infant of breast‐feeding being continued after the introduction of solid foods are reviewed. The limited evidence from industrialised countries suggests that prolonged partial breast‐feeding has little influence on child health and growth. In contrast, in poor areas of the developing world, the continuation of breast‐feeding for 1–2 years after the introduction of other foods appears to have several major benefits. These include the supply of nutrients, the delivery of protective, digestive and trophic agents, and extending the period of infertility in the mother. Partial breast‐feeding after 6 months is associated with reduced severity of infectious diseases particularly in severely malnourished individuals. There is no evidence that partial breast‐feeding plays a causal role in poor growth performance. In poor areas of the developing world, breast‐feeding, together with the provision of adequate amounts of other foods, should be encouraged for the first two years of life.

The importance of breast‐feeding in late infancy and early childhood varies considerably between developing and industrialised countries as a result of the wide differences in cultural and socioeconomic backgrounds of mothers who choose to breast‐feed for long periods (Table 2). In industrialised countries prolonged breastfeeding is more common amongst well‐educated, affluent, highly‐motivated mothers who have ready access to good quality weaning foods and health care. The limited evidence currently available suggests that neither child health nor growth are influenced by continuing to receive breast‐milk after 6 months in addition to appropriate amounts of other foods. In this situation, the decision to extend breast‐feeding into late infancy has to be based on family preferences. In contrast, there is a wealth of evidence to suggest that in poor areas of the developing world breast‐feeding after early infancy has a number of major benefits. Breast‐milk is an invaluable source of nutrients when the quality of weaning foods is low and food is in short supply. Breast‐feeding ensures a continuing supply of nutrients during the frequent illnesses experienced by children in these environments and delivers protective, digestive and trophic factors that may be important during the recovery process. In addition, the contraceptive effect of breast‐feeding in underprivileged mothers results in wide birth‐intervals, with the associated beneficial effects on child survival. At present, there is no evidence that prolonged partial breast‐feeding is detrimental to health or growth. On the contrary, the weight of evidence suggests that for children in the developing world breast‐feeding for the first 2 years of life should be actively encouraged.
Would Control of Childhood Infectious Diseases Reduce Malnutrition?
Authors: BLACK ROBERT E.
Published: January 2008

Infectious diseases and especially diarrheal diseases have been noted to have an adverse effect on the growth of underprivileged children in developing countries. Diarrheal diseases have been estimated to account for 10–80% of growth retardation in the first few years of life, with the magnitude of effect possibly modified by other factors, such as the adequacy and source of dietary intake, treatment and feeding practices during and following illness and the opportunity for catch‐up growth after illness. In the only study in which infectious diseases and routine dietary intake have been evaluated simultaneously, inadequate dietary intake rather than infectious diseases, was found to have the predominant role in growth faltering. Although reduction in infectious diseases is desirable for many reasons, the relative feasibility and cost of this approach to improve nutritional status must be compared with more direct nutrition interventions.
The Principles and Strategic Steps of a Simple Nutrition Message
Authors: JALIL FEHMIDA
Published: January 2008

High prevalences of protein‐energy malnutrition, anemia, vitamin A and iodine deficiencies have persisted since their identification by the National Nutrition Survey of Pakistan, 1966. While diarrhoea can be managed with oral rehydration therapy and iodine deficiency prevented with iodinization of salts, no simple tool for management of malnutrition is available. Strategies vary. In Pakistan, where the literacy rate is low but food grains are sufficient, precise and correct messages about nutrition education can potentially reduce the problem.
Latin America: Actions for the Prevention and Treatment of Malnutrition
Authors: O'DONNELL A. M. , BRITOS S.
Published: January 2008

The stagnation of the social and economic progress of Latin America in the 1980s is an aftermatch of its enormous external debt and of the drop in the international price of agricultural goods which are its main exports. Today in LA more people is malnourished and live under the line of poverty than in the 1970s. Programs for the prevention of malnutrition and for the rehabilitation of malnourished children have been enforced in most countries in order to mitigate the effects of the crisis. Such actions are briefly discussed.
Clinical Presentation and Natural Course of the Carbohydrate‐deficient Glycoprotein Syndrome
Authors: JAEKEN J. , HAGBERG B. , STRøMME P.
Published: January 2008

On the basis of 29 patients aged 1–48 years, the general clinical manifestations and natural course have been determined of a newly described autosomal recessive multisystem condition with carbohydrate‐deficient glycoproteins, particularly affecting transferrin. The syndrome showed different presentations during different age periods. During infancy and early childhood failure to thrive, liver dysfunction, pericardial effusions, marked developmental delay and stroke‐like episodes were most pronounced. In later childhood and adolescence stationary mental deficiency and ataxia, slowly progressive lower limb neuropathy and pigmentary retinal degeneration, as well as secondary skeletal deformities, were found to be the most disabling constituents. For the purpose of clinical recognition, a four‐stage progression based on age is presented.
Neurological Findings in the Carbohydrate‐deficient Glycoprotein Syndrome
Authors: BLENNOW GOSTA , JAEKEN JAAK , WIKLUND LARS MARTIN
Published: January 2008

The carbohydrate deficient glycoprotein (CDG) syndrome is a newly described disorder with a characteristic carbohydrate deficiency of glycoproteins. It is mainly a nervous system disorder, but other organ systems are also involved, such as the liver, the kidneys, the skeletal system, the subcutaneous adipose tissue and the pericardium. Based on twenty‐two cases, 2.5–48 years old, we describe the neurological features and evolution. In the neonatal and infantile age there was hypotonia, muscular weakness, developmental retardation, diminishing tendon reflexes and alternating esotropia. Preschool and early school age was characteristized by progressive polyneuropathy with muscular weakness and contractures, extrapyramidal signs (ataxia, dyskinesia, dysequilibrium), psychomotor retardation (I.Q. level of 40–60), transient stroke‐like episodes and retinitis pigmentosa. In puberty and adulthood the condition was rather stationary. They learned at best to walk with support, understand the spoken word well, and a few developed a fairly good linguistic skill. The dominating neuroradiological finding was pontine and cerebellar “atrophy”.
Studies on Perceived Breast Milk Insufficiency A Prospective Study in a Group of Swedish Women
Authors: HILLERVIK‐LINDQUIST CHARLOTTE
Published: January 2008

A prospective investigation of the course of breast‐feeding was carried out in a group of 51 healthy, well educated Swedish women during the period three days to 18 months after delivery. The aims were to investigate the incidence, causes and consequences of perceived breast milk insufficiency (transient lactation crises), by relating this phenomenon to the infant's breast milk consumption and growth, and to the course of breast‐feeding.

It was found that every second mother experienced transient lactation crises on at least one occasion (the crisis group). The crises were mostly caused by emotional disturbances in the mothers (e.g. anxiety, stress and discomfort), or by the infant's refusal to suckle, by unmotivated crying, or by illness.

Within the crisis group no significant difference was found between the infants’intake of breast milk during the crises compared with control measurements one week later. Nor had the crises any immediate impact on the growth of the infants. A comparison between the mothers with crises and those who did not experience any crises, revealed that the breast milk consumption among the infants in the crisis group was lower throughout with significant differences at three and five months. The infants in the crisis group also had a significantly lower weight at two, three, four and nine months, although both groups were above the NCHS mean.

The reasons for initiating breast‐feeding differed between the two groups. The crisis group tended to give infant‐related reasons to a higher degree than the mothers in the non‐crisis group who more frequently mentioned mother‐related motives. The mothers with crises also showed a greater ambivalence during the lactation period and terminated the breast‐feeding somewhat earlier. Consequently they also introduced taste portions and started the weaning significantly earlier.

Some general findings revealed a wide variation in breast milk consumption, not only between infants but also in the same infant from one occasion to another. The total energy intake was almost the same for the partially breast‐fed infants, receiving breast milk plus supplementary food, and those who were exclusively breast‐fed. Although most mothers in both groups initiated the weaning in accordance with general recommendations, a wide variation was also found in the length of the weaning period. In some cases it lasted for more than five months.
Longitudinal zinc balances in breast‐fed and formula‐fed infants
Authors: Sievers E , Oldigs H‐D , Dörner K , Schaub J
Published: January 2008

Longitudinal zinc (Zn) balance studies were performed under domestic conditions in term breast‐fed (n= 10), term formula‐fed (n= 5; Zn concentration in the formula: 4 mg/l) and preterm formula‐fed (n= 3) infants during the first 17 weeks of life. Samples of milk, urine and feces were analyzed by atomic absorption spectrometry. The median daily Zn intake in breast‐fed infants decreased from 0.592 (0.457‐0.829) mg Zn/kg body weight to 0.151 (0.095‐0.304) mg Zn/kg body weight in the first 17 weeks of life; comparable values for bottle‐fed term infants were 0.58 (0.511‐0.701) and 0.674 (0.529‐0.731) mg Zn/kg body weight. The median percent retention of Zn intake was 27 (‐60 to 81.4)% in breast‐fed infants and 21.5 (‐42 to 64)% in formula‐fed infants. In view of the urinary and fecal Zn losses measured, a daily intake of 0.3‐0.5 mg Zn/kg body weight is considered to be sufficient to ensure a Zn retention equivalent to breast‐fed infants. This requires a Zn concentration of 2‐3 mg/1 of Zn depending on milk volume intake.
Lidocaine for treatment of severe seizures in newborn infants. II. Blood concentrations of lidocaine and metabolites during intravenous infusion
Authors: Hellström‐Westas L , Svenningsen NW , Westgren U , Rosén I , Lagerström P‐O
Published: January 2008

The blood concentrations of lidocaine and its main active metabolites, methylethylglycinexylidide (MEGX) and glycinexylidide (GX), were measured in 24 newborn infants during anticonvulsive treatment with an iv infusion of lidocaine. After a bolus dose of 1.5–2.2 mg/kg and continuous infusion of lidocaine (4.7–6.3 mg/kg/h) there was accumulation of the drug and MEGX within 24 h. After termination of the iv infusion, both lidocaine and the metabolites were eliminated within 24–48 h. The anticonvulsive effectiveness–estimated by clinical observation and continuous amplitude integrated EEG monitoring (cerebral function monitor)–was immediate in 15 infants (nine term and six preterm). There was no correlation between blood concentrations of lidocaine and metabolites, and anticonvulsive effect (i. e. good, intermediate or no response). No differences in blood concentrations were found between full‐term and preterm babies, or between infants with or without birth asphyxia. In combination with a fast withdrawal of the drug, few adverse reactions were seen with the dosages used, even though blood concentrations were high. Routine measurements of lidocaine concentrations during anticonvulsive treatment in neonates seem to be of little clinical value. For evaluation of the anticonvulsive effect and for early detection of seizure activity during lidocaine withdrawal, continuous EEG monitoring is preferable.
Superior treatment results in females with high‐risk acute lymphoblastic leukemia in childhood
Authors: Lanning M , Garwicz S , Hertz H , Jonmundsson G , Kreuger A , Lie SO , Moe PJ , Salmi TT , Schröder H , Siimes MA , Wesenberg F , Yssing M , Åhström L , Gustafsson G
Published: January 2008

In this population‐based study, 808 children aged 1–15 years from Denmark, Finland, Iceland, Norway and Sweden, were diagnosed between July 1981 and June 1986 as suffering from non‐B‐cell acute lymphoblastic leukemia (ALL). The total population was 4.5 million children. Remission was achieved in 770/808 of the patients (95%). No sex difference in the remission rate was observed. The event free survival (EFS) at 102 months was 0.47 for males and 0.62 for females (p< 0.001). There was no difference in EFS between males and females with standard‐risk (0.58 and 0.60) or intermediate‐risk (0.47 and 0.60) ALL, respectively. The EFS for females with high‐risk ALL (0.68) was superior to that of males with high‐risk ALL (0.31). Cox multivariant analysis showed that white blood cell count, sex, age and thrombocyte count were significant prognostic factors in all children. The intensified treatment according to the prognostic factors used in this study led to equal EFS for females with ALL from all risk groups. Males with high‐risk ALL, however, did not benefit from the intensified treatment.
Cholelithiasis during the first year of life: case reports and literature review
Authors: Ljung R , Ivarsson S , Nilsson P , Solvig J , Wattsgård C , Borulf S
Published: January 2008

Five cases are reported of children with gallstones diagnosed by ultrasound during their first 7 months of life. Of the four with symptomatic gallstones, one subsequently developed vitamin K deficiency syndrome with profuse bleedings. The children, who belonged to a defined population, were all diagnosed within an 18‐month span, suggesting the frequency of early gallstone formation to be higher than formerly supposed. One child had haemolytic anaemia, but none of the conventional risk factors for stone formation was present in the other four cases.
Cushing's syndrome due to primary pigmented nodular adrenocortical disease with cardiac myxomas and mucocutaneous lentigines
Authors: Ichiba Y , Nishizaki Y , Tanizaki M
Published: January 2008

A young Japanese female demonstrated unusual features of Cushing's syndrome, cardiac myxomas and mucocutaneous lentigines. At the age of 12 years she presented with growth failure and obesity. The dexamethasone suppression test, the metyrapone test and low corticotropin concentrations indicated a primary adrenal disorder. At surgery, the adrenal glands were not enlarged (the right, 4.0 g; the left; 4.5 g) but had numerous small dark brown nodules. The pathological findings showed multiple small black cortical nodules containing large cells with eosinophilic cytoplasm and lipofuscin, and internodular cortical atrophy. These abnormalities were consistent with primary pigmented nodular adrenocortical disease. At age 22 years she complained of fatigue and palpitations associated with mid‐chest pain. Four cardiac myxomas, suspected from the echocardiogram, were surgically removed. Because Cushing's syndrome and cardiac myxomas are life‐threatening conditions, an awareness of the complex is important.
Methods of resuscitation in low‐Apgar‐score newborn infants— a national survey
Authors: Palme‐Kilander C
Published: January 2008

The incidence, treatment and immediate course in infants with postnatal apnoea were studied. Information on all infants born in Sweden in 1985 with a low Apgar score (3 or less at 1 min or 6 or less at 5 min) was collected from the midwife and from the baby's chart. Of the 97 648 live births, 1633 (1.7%) had a low Apgar score. The risk increased with decreasing birthweight and with severe malformations. Before delivery, 19% of the low‐Apgar‐score infants were not expected to require resuscitation. Eighty percent of the ventilated infants were satisfactorily ventilated by bag and mask; the remainder were intubated. Of the ventilated infants, 78% developed spontaneous breathing within 10 min after birth and 89% within 20 min. Routine intubation or administration of buffer in cases of postnatal asphyxia had no influence on the time to onset of regular spontaneous breathing.
Insensible water loss from the skin during phototherapy in term and preterm infants
Authors: Kjartansson S , Hammarlund K , Sedin G
Published: January 2008

The rate of evaporation from the skin was measured before and during phototherapy in 10 full‐term and seven preterm infants (gestational age 29‐33 weeks). The method for measurement of rate of evaporation was non‐invasive and was based on determination of the water vapour pressure gradient close to the skin surface. All infants were studied naked in an incubator with an ambient relative humidity of 50% and with a controlled environment with respect to temperature and air velocity. In the term infants the mean rate of evaporation, measured from an interscapular skin area, was 3.1 g/m2h both before and after 30 min of phototherapy. In the preterm infants the corresponding value was 9.8 g/m2h before and 9.7 g/m2h after 120 min of phototherapy. Thus, in thermally stable infants, nonionizing radiation from phototherapy equipment does not increase water loss from the skin.
Essential fatty acids in human colostrum
Authors: And Ragnhild Renneberg , Skåra Bjørg
Published: January 2008

We analyzed the colostrum of 11 mothers, consuming a normal hospital diet, for total fat content and various fatty acids. Three of the mothers had given birth four weeks prematurely. Total fat content of the colostrum ranged from 2.16 to 3.65 g/100 ml. The major fatty acids were palmitic acid (16:0) and oleic acid (18:1) (24.3 and 39.7% (w/w), respectively). The dominating polyunsaturated fatty acid was linoleic acid (18:2n‐6) (11.5% of the total fatty acids). Linolenic acid (18:3n‐3) and docosahexaenoic acid (22:6n‐3) accounted for 0.7 and 0.6%, respectively, of the sum of total fatty acids. The ratio of polyunsaturated to saturated fatty acids was 0.42, ranging from 0.28 to 0.5, and the ratio of n‐6/n‐3 fatty acids was 6:1. Linoleic acid and linolenic acid were positively correlated with each other (p< 0.02), whereas palmitic acid was negatively correlated with oleic acid (p< 0.05). We conclude that theaveragehuman colostrum contains the recommended level and balance of the essential fatty acids required by the newborn baby.
Chlamydia trachomatis in neonatal respiratory distress of very preterm babies: biphasic clinical picture
Authors: Sollecito D , Midulla M , Bavastrelli M , Panero A , Marzetti G , Rossi D , Salzano M , Roggini M , Bucci G
Published: January 2008

We observed 12 very preterm infants (10 males) with a peculiar respiratory syndrome characterized by early onset soon after birth and by a biphasic course. The severe first phase was characterized by a clinical pattern mimicking the idiopathic respiratory distress syndrome of prematurity. Gradually, respiratory symptoms decreased and assisted ventilation with oxygen therapy was reduced. In the second phase, a significant worsening of respiratory signs and the appearance of apneic spells were observed. Chest X‐ray showed hypoexpansion of the lungs and the prevalence of a fine reticular pattern. Chlamydia trachomatis was identified in this second phase in conjunctival and pharyngeal swabs and/or on tracheal aspirates. Our data suggest that in the very preterm infants, chlamydial infection shows different clinical and laboratory features if compared with Chlamydia trachomatis pneumonia of infants born at term.
Neurological adaptation of infants delivered by emergency or elective cesarean section
Authors: Otamiri G , Berg G , Finnström O , Leijon I
Published: January 2008

The effects of intrapartal asphyxia on neonatal neurological condition have been studied in 17 full‐term infants delivered by emergency cesarean section and in 30 full‐term infants delivered by elective cesarean section used as controls. A neurological examination consisting of 31 items was performed on days 1, 2 and 5 after birth. A tonus score, an excitability score as well as the number of optimal responses were calculated. A follow‐up examination was done at six months of age with a standardized neurological and developmental examination. The results showed that infants born after emergency cesarean section were significantly more hypotone the first two days after delivery than the infants in the elective cesarean section group. In regard to individual neurological items, significant differences were found between the emergency and elective cesarean section in reaction to sound, rooting, patellar, Moro and stepping reflexes with weaker reactions in the elective cesarean section group. Growth, psychomotor development and neurological status at six months did not differ significantly between the groups. Our findings indicate that full‐term infants born after emergency cesarean section due to mild intrapartal asphyxia have a delayed neurological adaptation as expressed by poor muscular tonus during their first days of life compared with infants born after elective cesarean section.
Gestational age correction for height in preterm children to seven years of age
Authors: Elliman AM , Bryan EM , Elliman AD , Harvey DR
Published: January 2008

Correction for gestational age continues to make a difference to the height SD score (SDS) to the age of seven years in very preterm babies. The height SDS for children born at 28 weeks' gestation increased by 0.25 SDS when postconceptual age was used instead of real age. Extrapolating from these results, the effect of correction would be an increase of approximately 0.32 SDS for a seven‐year‐old of 24 weeks' gestation. Unsatisfactory growth may be masked by a steady or increasing real age SDS in a few children. The risks of stopping using postconceptual age at two or three years include both false confidence in genuine cases of growth retardation and misinterpretation of a decrease in height SDS as evidence of growth retardation. As the number of very preterm babies who survive increases so does the importance of these observations.
Macromolecular absorption in small‐for‐gestational‐age infants
Authors: Boehm G , Jakobsson I , Månsson M , Räihä NCR
Published: January 2008

Using human α‐lactalbumin as a marker protein, macromolecular absorption was studied in 40 preterm infants, appropriate for gestational age (AGA), in 12 AGA term infants and in 18 preterm infants, small for gestational age (SGA). The absorption of α‐lactalbumin was measured as concentration in serum after a human milk feed and expressed as μg α‐lactalbumin/1 serum/1 human milk/kg body weight on day 7, 14, 21 and 42 after delivery. The serum concentration of α‐lactalbumin was correlated negatively with maturity and postnatal age. In the SGA infants, the concentration of α‐lactalbumin was significantly higher than in the AGA infants of similar gestational age. The data show that intrauterine growth retardation causes a delayed postnatal decrease in macromolecular absorption. This may indicate delayed intestinal maturation.
Efficacy of “high‐intensity” blue‐light and “standard” daylight phototherapy for non‐haemolytic hyperbilirubinaemia
Authors: Tan KL , Lim GC , Boey KW
Published: January 2008

We report our clinical experience with phototherapy in 3802 infants; 3629 were exposed to “standard” daylight phototherapy and 173 to “high‐intensity” blue‐light phototherapy. High‐intensity blue‐light phototherapy was twice as effective as standard daylight phototherapy in decreasing bilirubin concentrations. No failures occurred with high‐intensity phototherapy compared with an overall failure rate of 1.84/1000 with daylight lamps; these cases were transferred to high‐intensity phototherapy with prompt response. Rebound after cessation of phototherapy was greater in those exposed to high‐intensity blue light with a significantly greater number requiring a second exposure. However, the incidence was still low. No third exposure was required in any infant. Nursing of infants under high‐intensity blue light was more difficult and inconvenient as was clinical monitoring. The light also caused more stress on the nursing and medical personnel. However, the infants tolerated both types of phototherapy equally well. High‐intensity blue‐light phototherapy would seem to be the treatment of choice for infants with rapidly increasing or very high bilirubin levels, as well as in those not responding adequately to daylight phototherapy.
Effect, of measles‐mumps‐rubella vaccination on polymorphonuclear neutrophil functions in children
Authors: Toraldo R , Tolone C , Catalanotti P , Ianniello R , D'Avanzo M , Canino G , Galdiero F , Iafusco F
Published: January 2008

Adherence, metabolic burst and chemotaxis of polymorphonuclear neutrophils (PMNs) were examined in 15 children before and seven days after measles‐mumps‐rubella vaccine administration. In all children, PMN functions were significantly reduced on the seventh day. Adherence, metabolic burst and chemotaxis tested in three subjects one month after vaccination had returned to normal values. Only two children presented transient hyperpyrexia. We conclude that measles‐mumps‐rubella vaccine administration suppresses PMN functions without clinical consequences. This is probably because attenuated strains of vaccine viruses do not replicate in lymphoid tissues as extensively as do wild‐type strains.
Borrelia arthritis in Swedish children: clinical manifestations in 10 children
Authors: Hammers‐Berggren S , Andersson U , Stiernstedt G
Published: January 2008

Since 1986, serology against Borrelia burgdorferi has been performed on patients with arthritis admitted to the Division of Pediatric Rheumatology, S:t Göran's Hospital, Stockholm. We studied, retrospectively, the period 1986–88. Among 300 children with arthritis, 10 had positive titers against B. B. burgdorferi. Other causes of arthritis were excluded. The onset of Borrelia arthritis was throughout the year. Only 3 of the 10 children remembered an actual tick bite. No other manifestations of Lyme borreliosis were present simultaneously. The typical clinical picture was a relapsing unilateral arthritis of the knee.
Absences for sickness among children in day care
Authors: Möttönen Merja , Uhari Matti
Published: January 2008

The number of days of absence because of sickness, recorded for all children in one city in Finland, cared for in municipal day care over a period of 2.5 years, was collected from the monthly figures kept by the city council office for accounting purposes. The average number of days of absence per child was 24 per year at child‐care centers and 9 in family care (p < 0.01) at age less than 3 years, 13 and 7, respectively (p < 0.05) at age 3–5 years, and 10 and 5, respectively (p < 0.05) among those aged 6 years. The average duration of absence in all age groups was 3.6 days in child‐care centers and 2.5 days in family‐care centers. The number of days absent at each child‐care center in 1986 correlated significantly with that for 1987 (r=0.58, p < 0.001), indicating consistency in the absence figures. A bivariate analysis showed the number of children in the child‐care centers (r= 0.32, p < 0.05) to explain the number of absences for sickness, and after this factor had been controlled in a multivariate analysis, the number of nurses serving out food while looking after the children (r= 0.27, p < 0.01) and the number of families to whom the children belonged (r=0.27, p < 0.01).
Rupture of the trachea: an unusual complication of delivery
Authors: Høgåsen Anne Kirsti Myrvang , Bøe Gunnar , Finne Per H
Published: January 2008

We describe a neonate whose trachea ruptured during delivery. The baby developed respiratory symptoms shortly after delivery and became dramatically ill after 6 h. This particular birth trauma appears to be very unusual: there are few cases reported in the literature. Rupture of the trachea should be considered as a differential diagnosis in a neonate who develops pneumomediastinum after a complicated delivery.
Low renal net acid excretion, high calciuria and biochemical signs of sodium deficiency in low‐birth‐weight infants fed a new low‐phosphorus formula
Authors: Manz F , Diekmann L , Kalhoff H , Stock GJ , Kunz C
Published: January 2008

In 11 infants (birth weight greater than 1800 g) fed a new type of humanized formula with a low phosphorus (P) content (calcium (Ca) 11 mmol/1, P 7.2 mmol/1, sodium (Na) 8.3 mmol/1) biochemical parameters of blood, serum and urine were determined. In nine boys Ca and P balances were evaluated also. Renal net acid excretion was low (0.85 mmol/kg/day). Mean concentrations of P and Ca in urine were 0.34 mmol/kg/day (10.5 mg/kg/day) and 0.1 mmol/kg/day (4 mg/kg/day), respectively. In four infants, Ca concentration in urine was, however, greater than 0.15 mmol/kg/day) (6 mg/kg/day). In infants with birth weights greater than 1800 g fed the new, low‐P formula, the low renal net acid excretion, the normal P and the high Ca concentrations in urine were comparable to term infants fed human milk. The high calciuria in several infants may be normal physiologic values. However, it remains to be established that the urinary solubility product of infants fed the new, low‐P formula is in the same range as those for infants fed human milk. Unexpectedly, low urinary Na excretion (0.26 mmol/kg/day) and increased urinary excretion of aldosterone‐18‐glucuronide indicated biochemical evidence of Na deficiency secondary to low Na intake and a high weight gain. If the new, low‐P formula is to be fed to infants with a birth weight as low as 1800 g, Na content should be higher than in mature human milk because of the often relatively higher weight gain.
Non‐nutritive sucking does not increase blood levels of gastrin, motilin, insulin and insulin‐like growth factor 1 in premature infants receiving enteral feedings
Authors: Kanarek Keith S , Shulman Dorothy
Published: January 2008

Non‐nutritive sucking in premature infants accelerates weight gain for unclear reasons. The effects of non‐nutritive sucking on enteral hormone secretion may augment digestion and/or absorption of nutrients. Blood concentrations of gastrin, motilin, insulin and insulin‐like growth factor‐1 were measured before and 72 h after the initiation of nasogastric feedings in 21 premature infants randomly assigned to either a non‐nutritive suckling or control group. Gastrin and motilin concentrations increased significantly after feedings in all infants (mean ± SEM) (gastrin, 4 ± 4 to 73 ± 9 pg/ml, p<0.01; motilin, 141 ± 5 to 181 ± 3 pg/ml, p<0.01) Pre‐ and post‐feed insulin concentrations were greater in the non‐nutritive sucking group receiving bolus feeds than in control infants who were bolusfed (P<0.01). Non‐nutritive sucking in premature infants does not appear to alter blood concentrations of motilin, gastrin, insulin or insuline‐like growth factor‐1 three days after initiation of feedings. If changes in the secretion of these hormones are induced by non‐nutritive sucking, they may be at a local paracrine level.
Anaemia and macrocytosis—unrecognized features in cartilage‐hair hypoplasia
Authors: Mäkitie O , Rajantie J , Kaitila I
Published: January 2008

Cartilage‐hair hypoplasia is an autosomal recessive osteochondrodysplasia which results in short stature, sparse hair and impaired cell‐mediated immunity. In a study of 88 Finnish patients we found episodes of anaemia and/or macrocytosis during childhood in 86% of the patients. The reticulocyte index was always low in relation to anaemia. Bone marrow examination revealed decreased erythropoiesis in six of eight anaemic patients studied. Anaemia was most prevalent and severe during infancy. Spontaneous recovery occurred before adulthood in all patients except in three infants with fatal hypoplastic anaemia. Sixty‐two percent of the patients had had lymphopenia and 24% neutropenia. Presence of anaemia significantly correlated to severity of immunodeficiency and growth failure and to presence of neutropenia. Disordered erythrogenesis is an integral feature of cartilage‐hair hypoplasia and may, together with growth failure and immunodeficiency, reflect a generalized defect in cellular proliferation.
Takayasu's aortitis with renovascular hypertension
Authors: Ivarsson S‐A , Bergqvist D , Lundström NR , Maly E , Nilsson KO , Wattsgård C
Published: January 2008

We report a case of Takayasu's disease with severe renovascular hypertension in a girl from Eritrea. In the “burn‐out” phase after the erythrocyte sedimentation rate had normalized, reconstructive vascular surgery was performed as further progression of the disease seemed unlikely. However, probably due to her growth, the graft rotated and a second operation was successfully performed.
Cystic adult granulosa cell tumor causing precocious pseudopuberty in a six‐year‐old girl
Authors: Arisaka O , Matsumoto T , Hosaka A , Shimura N , Nakayama Y , Fujita H , Yamashiro Y , Yabuta K
Published: January 2008

A very rare occurrence of adult granulosa cell tumor of the ovary (not of the juvenile type) causing precocious pseudopuberty in a six‐year‐old girl is described. An additional feature of interest was that the tumor appeared entirely cystic. To our knowledge, this condition in such a young premenarchal patient has not been reported previously.
Gastroesophageal reflux in children with recurrent abdominal pain
Authors: Meer SB van der , Forget PP , Kuijten RH , Arends JW
Published: January 2008

In this study we investigated the presence of gastroesophageal reflux in children with recurrent abdominal pain and its possible relationship to food intolerance‐associated duodenal inflammation. Twenty‐four‐hour intra‐esophageal pH monitoring, an endoscopic duodenal biopsy and a small bowel 51Cr‐EDTA permeability test were performed in 25 children with recurrent abdominal pain. In 14 cases (56%) the pH monitoring was abnormal, pointing to the presence of pathological gastroesophageal reflux. Treatment of gastroesophageal reflux in the latter patients resulted in resolution or improvement of abdominal pain in 10 cases (71%). Gastroesophageal reflux did not appear to be associated with either intestinal permeability to 51Cr‐EDTA or duodenal biopsy findings. We conclude that pathological gastroesophageal reflex is a frequent finding in children with recurrent abdominal pain, that it is unrelated to duodenal inflammation and that there might be a causal relationship between pathological gastroesophageal reflux and recurrent abdominal pain in children.
Polymerase chain reaction for detection of Mycobacterium tuberculosis
Authors: Narita M , Shibata M , Togashi T , Kobayashi H
Published: January 2008

Rapid diagnosis of tuberculosis is essential, and therefore we use a polymerase chain reaction. In this report, we describe two cases of tuberculous lymphadenitis in childhood. Although histopathological findings were not specific for tuberculosis in both cases, distinct positive bands were amplified. For DNA diagnosis of tuberculosis, a lysis method of extracting chromosomal DNA from lipid‐rich cell walls of mycobacteria is of critical importance. We made use of a simple lysozyme‐proteinase K treatment for biopsied tissues. Although this extraction procedure was less efficient than those reported previously, it was considered sufficient for detecting mycobacterial DNA with the use of a highly sensitive polymerase chain reaction. We conclude that DNA amplification in combination with lysozyme lysis can be used routinely in clinical laboratories as a rapid and sensitive test for the diagnosis of tuberculosis.
Collagen type II in Langer‐Saldino achondrogenesis: absence of major abnormalities in a less severe case
Authors: Bätge B , Nerlich A , Brenner R , Yang C , Müller PK
Published: January 2008

Collagen extracted either from cartilage or synthesized in vitro was analyzed to identify possible molecular defects in the cartilaginous matrix of a male fetus suffering from a mild form of type II achondrogenesis (Langer‐Saldino). The tissue architecture of the patient's cartilage was markedly altered and showed numerous fibrous vascular canals which were focally stained by antibodies against collagens I and III. Collagen II was present, although heterogenously distributed throughout the cartilaginous matrix. Upon electrophorctic separation, however, the patient's femoral head cartilage showed the presence of collagens II, IX and XI only, which was similar to an age‐matched control. The hydroxyproline/hydroxylysine ratio of collagen II of the patient was not significantly different from that of the control. Likewise, the compositions of collagens synthesized by cultured chondrocytes as well as fibroblasts were similar in the patient and the control. The results provide strong evidence that, in the present mild case of Langer‐Saldino achondrogenesis, collagen II is expressed and regularly hydroxylated at its lysyl residues. This may indicate that cartilage components other than collagen II may be responsible for the altered tissue organization observed. Along with previous observations, our data suggest that the degree of biochemical matrix alterations may be related to the severity of the clinical phenotype.
Influence of surgical treatment of scoliosis in children with spina bifida on ambulation and motoric skills
Authors: Müller E Berned , Nordwall A , Wendt L von
Published: January 2008

The influence on motoric skills of surgical treatment of scoliosis in 14 children with myelomeningocele was studied. Fifty percent of the children had increased flexion contractures of the hips at follow‐up, and all but one patient had impaired motor ability. There was no influence on activities of daily life, but 57% of children had lost some of their ambulation capacity. Postoperative physiotherapy is highly advisable. Intensive attempts to treat these children conservatively to prevent scoliosis progression is suggested.
Comparison of antithrombin III, protein C and protein S levels in capillary and venous blood of newborn infants
Authors: Fok TF , Yin JA , Yuen PMP
Published: January 2008

The plasma concentrations of antithrombin III, protein C and protein S in capillary and venous blood samples obtained simultaneously from 30 neonates were compared in order to determine the suitability of using capillary blood for estimation of these proteins with anticoagulant action. Our findings showed that while capillary and venous blood did not differ significantly in antithrombin III functional activity and protein C antigen levels, the capillary samples had significantly lower protein C functional activity and higher antithrombin III antigen level. Protein S antigen level was also significantly higher in the capillary samples although the difference was relatively small. The capillary and venous concentrations of the binding protein of protein S, C4b binding protein, were almost identical.
Medical vocational guidance for adolescents–is it effective?
Authors: Bremberg S , Andersson R
Published: January 2008

The outcome of school medical vocational guidance was studied in all 1595 students enrolled in 1987 in grade 9 in the primary schools of Linköping. In grade 9, the school health service had listed 249 students with a chronic disorder. These were sent a questionnaire which was answered by 235 students. Only 5/235 stated that vocational information from physicians and school nurses had been important for their choice of career. No more than 22/235 had chosen a medically ill‐suited secondary school study course. This figure is close to the number expected, assuming that all choices of study courses are at random. At follow‐up in May 1989, no one said that they had changed study course or work due to their medical disorder. Thus, school medical vocational guidance seems to have little effect on the vocational choices of adolescents with chronic disorders.
Thiazide therapy for ACTH‐induced hypercalciuria and nephrolithiasis
Authors: Katzir Ze'ev , Shvil Yigal , Landau Ezekiel H , Popovtzer Mordecai M
Published: January 2008

A one‐year‐old boy presented with hypercalciuria and nephrolithiasis following a course of ACTH therapy for infantile spasms. After a successful cystolithotripsy, therapy with chlorothiazide was followed by regression of the hypercalciuria within 42 months. Neither nephrolithiasis nor nephrocalcinosis recurred. Therapy with thiazides to prevent hypercalciuria caused by ACTH is proposed.