bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of chronic knee pain in children and adolescents in northern Finland
Authors: Vahasarja V
Published: January 2008

A questionnaire was sent to 967 schoolchildren, in two age groups, in northern Finland in order to investigate the prevalence of chronic knee pain. A response rate of 88.5% was achieved. Adolescents (aged 14‐15 years) had significantly more knee pain (p < 0.0001) than children (aged 9‐10 years). The total prevalence of chronic knee pain at the time of the evaluation was 18.5% among adolescents and 3.9% among children. There was no significant difference in the prevalence of chronic knee pain between boys and girls in these age groups. Overweight was not a predisposing factor in chronic knee pain. Child, knee, pain
Prevalence of and factors associated with childhood asthma in Hong Kong
Authors: Lau YL , Karlberg J , Yeung CY
Published: January 2008

The prevalence of asthma and eczema in children between 3 and 10 years of age living in Hong Kong was determined by a questionnaire survey administered to the parents of 535 children in 1989. The prevalence of asthma was 6.0% (95% confidence limit (CI) 4.0‐8.0%) and the prevalence of eczema 6.8% (95% CI 4.6‐9.0%). Age, sex, parental smoking and breast feeding in early life did not show significant associations with asthma. However, four different measures were associated with the prevalence of asthma: the presence of eczema, high serum IgE level, high number of upper respiratory infections and a relatively high family income, with odds ratios of 7.6, 4.9, 4.5 and 2.7, respectively.
Weaning practices in children up to 19 months of age in Madrid
Authors: Van Den Boom SAM , Kimber AC , Morgan JB
Published: January 2008

The weaning practices of 344 children in Madrid, aged 3‐19 months, were investigated by controlled interview of their mothers or caretakers. The results were compared with national and international guidelines for the introduction of complementary foods; there are no Spanish guidelines. We found only minor differences between the practices in three different socioeconomic groups. Generally, mothers in Madrid followed national and international guidelines well. However, more attention should be paid to aspects such as the timing of the introduction of the first complementary food, the nature of gluten, the addition of salt and sugar to baby meals and the introduction of potentially allergenic foods. Also, manufacturers of baby foods that are sold in Spain could play a useful role by reducing the number of ingredients used in products advised for the initial phase of weaning and by avoiding the use of salt and sugar in their products.Complementary food, infant nutrition, socioeconomic group, weaning

SAM van den Boom, Dona Juana I de Castillo 56, 4‐A, 28027 Madrid, Spain
Interleukin‐6 in cerebrospinal fluid of patients with central nervous system infections
Authors: Matsuzono Y , Narita M , Akutsu Y , Togashi T
Published: January 2008

Interleukin(IL)‐6 levels were measured in cerebrospinal fluid (CSF) and serum samples from pediatric patients with central nervous system (CNS) infections by means of an enzyme‐linked immunosorbent assay. Mean IL‐6 concentrations in CSF samples from patients with bacterial meningitis (49017 44 730 pg/ml) were significantly higher than those in patients with aseptic meningitis (10761572 pg/ml) or encephalitis (409835 pg/ml). In aseptic meningitis and encephalitis, IL‐6 levels in serum were within the lower ranges (< 100 pg/ml), in contrast with the highly elevated levels found in bacterial meningitis (14 33218 385 pg/ml). In 5 of the 15 patients with encephalitis, elevated levels of IL‐6 were observed in the initial CSF samples despite normal findings of routine CSF examinations. Also, sequential CSF samples revealed that there was an increase in the CSF cell count in two of the five patients. These results validated the potential of measuring IL‐6 in CSF samples for the purpose of providing additional information on routine laboratory test results. D Central nervous system infection, cerebrospinal fluid, children, enzyme‐linked immunosorbent assay, interleukin‐6.

M Narita, Department of Pediatrics, Hokkaido University School of Medicine, N 15 W 7, Kita‐ku, Sapporo 060, Japan
Short versus long initial prednisone treatment in steroid‐sensitive nephrotic syndrome in children
Authors: Ksiek J , Wyszyska T
Published: January 2008

A total of 184 children aged, 13 months to 11 years, suffering from their first attack of steroid‐responsive nephrotic syndrome were included in a randomized study. They were treated according to three treatment protocols. All children received l‐2mg of prednisone/kg body weight/day (up to 80 mg daily) for 4 weeks, and thereafter 1 mg/kg body weight/48 h for the next 4 weeks. Treatment was discontinued at this point in 44 children (protocol A); in 68 (protocol B) the dose was reduced by 25% each week, tapering off to 0 at the end of the third month, while in 72 children (protocol C), after the first 2 months of initial treatment the dose was reduced by 25% each month and tapered off to 0 by the end of the sixth month. All patients completed a 2‐year follow‐up period after withdrawal of prednisone. Treatment results were expressed as: percentage of children relapse‐free within the first 6 months and 2 years after withdrawal of treatment, and average number of relapses per patient per year. The best results were obtained in children who had been treated for 6 months: 65.3% of them remained relapse‐free within the first 6 months and 50% over the entire 2‐year follow‐up period; the number of relapses per patient per year in this group was 0.49. The respective values for children treated 2 and 3 months were: 36.4% and 32.4% for the 6‐month period; 27.3% and 20.6% for the 2‐year period; the numbers of relapses per patient per year were 0.79 and 0.77, respectively. The frequency of corticosteroid side effects such as transient hypertension and cushingoid obesity during the initial treatment, and growth retardation or recurrent “respiratory tract” infections observed during the following 2‐year follow‐up period, did not increase after prolongation of the initial treatment.Initial treatment period, steroid‐sensitive nephrotic syndrome

J Ksiek, Department of Nephrology, Child Health Centre, 04‐736 Warsaw, Poland
Frequency, clinical and laboratory features of thyroiditis in girls with Turner's syndrome
Authors: Radetti G , Mazzanti L , Paganini C , Bernasconi S , Russo G , Rigon F , Cacciari E
Published: January 2008

A total of 478 patients, mean age 15.5 (3.6‐25.3) years, suffering from Turner's syndrome, were studied in order to determine the frequency of autoimmune thyroiditis, which is defined as the presence of antithyroid antibodies (AT‐Ab) and typical ultrasound findings. We found 106 (22.2%) patients positive for AT‐Ab and of those 49 (10%) also had positive ultrasound findings, and were therefore considered to be affected by thyroiditis. This frequency is significantly higher (p < 0.001) than that seen in the normal population. Goitre was detected on clinical examination in only 16 (33%) and by ultrasound in 19 (39%) patients. Hormonal evaluation showed that 17 patients were euthyroid, 27 had compensated hypothyroidism, 2 were hypothyroid and 3 were in a hyperthyroid phase. Clinical signs or symptoms of hypothyroidism were absent in all hypothyroid patients. In patients with thyroiditis, neither a higher frequency of malformations and autoimmune diseases nor a correlation with karyotype, oestrogens or growth hormone therapy was found.Antithyroid antibodies, thyroiditis, thyroid hormones, thyroid ultrasound, Turner's syndrome

G Radetti, Department of Paediatrics, Regional Hospital of Bolzano, via L Boehler 5, 39100 Bolzano, Italy
Birth asphyxia: incidence, clinical course and outcome in a Swedish population
Authors: Thornberg E , Thiringer K , Odeback A , Milsom I
Published: January 2008

A total of 42 203 live infants were born in Goteborg in 1985‐1991, and 292 term infants had Apgar scores < 7 at 5 min. Infants with congenital malformations, infections and opioid‐induced respiratory depression were excluded and thus 227 infants were included in the birth asphyxia group, which formed the basis of this retrospective study. Clinical signs of mild, moderate or severe hypoxic‐ischemic encephalopathy (HIE) were present in 65 infants, and in another 10 infants, sedated and on controlled ventilation, HIE was assumed but grading was not possible. The incidences of Apgar scores < 7 at 5 min, birth asphyxia and birth asphyxia with HIE were 6.9, 5.4 and 1.8 per 1000 live born infants: 95% of infants resuscitated with bag and mask ventilation only, did well, compared with 1 of 11 in whom resuscitation included adrenaline. Seizures occurred in 27 of 227 infants, beginning in 18 infants within 12 h of birth. Small‐for‐gestational‐age (SGA) infants were overrepresented in the birth asphyxia group but not in the birth asphyxia‐HIE group. All infants with severe HIE died or developed neurological damage. Half of the infants with moderate, and all of the infants with mild, HIE were reported to be normal at 18 months of age. A total of 0.3 per 1000 live born infants died and 0.2 per 1000 developed a neurological disability related to birth asphyxia. The disabilities were dyskinetic (4), tetraplegic (2), spastic diplegic (2), cerebral palsy and mild neuromotor dysfunction (1). The relatively low incidences of birth asphyxia and HIE were probably due to effective antenatal care.Asphyxia neonatorum, cerebral palsy, hypoxic‐ischemic encephalopathy, incidence, outcome, population, resuscitation, seizures, term infant

E Thornberg, Department of Pediatric Anesthesia and Intensive Care, Östra Hospital, S‐416 85 Göteborg, Sweden
Vitamin D deficiency rickets in breast‐fed infants presenting with hypocalcaemic seizures
Authors: Ahmed I , Atiq M , Iqbal J , Khurshid M , Whittaker P
Published: January 2008

At the Aga Khan Hospital (AKUH), 65 infants presented with hypocalcaemic seizures, subsequently found to have rickets. Forty‐six infants less than 6 months were totally or predominantly breast fed. In a subgroup of 15 mothers and their infants, we found very low plasma levels of 25(OH) vitamin D of < 5 /ig/1 and 7.53.3$uMg/l, respectively. Neither mothers nor infants received vitamin D supplementation. Maternal vitamin D deficiency and non‐supplementation in the infants were the likely causes of rickets in our patients. Prophylactic vitamin D 400 i.u. administered to infants up to 2 years and 800 i.u. to women in pregnancy and during lactation is recommended to prevent vitamin D deficiency.
Postoperative chylous ascites
Authors: Mladini‐Vuli D , Krelj V , Balarin L , Saraga M , Budimir D , Vukic Z
Published: January 2008

The case of an infant, aged 2 months and 23 days, with chylous ascites after nephrectomy is reported. Nephrectomy was performed because of a large hydronephrosis. Chylous ascites was treated with medium‐chain triglycerides, diet and cholestyramine. After 3 days the volume of the abdomen was reduced and on day 8 chylous ascites was not visible clinically or ultrasonographically. D Cholestyramine, chylous ascites, infant, medium‐chain triglycerides.

D Mladini‐Vulic, Sukoianska 37, 58000 Split, Croatia
Defining childhood obesity: the relative body mass index (BMI)
Authors: Poskitt EME
Published: January 2008

This article is a statement from the European Childhood Obesity Group after discussion with the participants at the 3rd ECOG Workshop in St Polten, Austria, 1993: W Burniat, M Caroli, C Catassi, ML Frelut, E Locard, E Malecka‐Tendera, C Maffeis, D Molnar, EME Poskitt, IM Raetsch, MF Rolland‐Cachera, C Van Aelst, L Vido, M Wabitsch, K Zwiauer.‐
Rett syndrome: clinical peculiarities and biological mysteries
Authors: Hagberg B
Published: January 2008

Rett syndrome, a peculiar neurodevelopmental deficiency affecting females, which starts in early childhood, is reviewed based on a Swedish series of 170 females, 2‐52 years of age (to December 1994). To date, the well recognized classical phenotype was found in 75% of cases. Atypical variant forms, mainly more mildly affected mentally retarded girls and adolescent women, were still in a minority, but constitute, with increasing experience, an expanding cohort. The biology and genetics of the condition seem puzzling. Traditional neurodegenerative pathology has been excluded. An age‐limited neurodevelopmental, as yet unknown, brain growth deficiency, is at present indicated. The syndrome is most probably genetically determined, but the mode of transmission is not convincingly compatible with any known pattern.Rett syndrome, review

B Hagberg, Department of Paediatrics, East Hospital, S‐416 85 Gothenburg, Sweden
Tracking of serum lipids and dietary energy, fat and calcium intake from 1 to 15 years
Authors: Boulton TJC , Magarey AM , Cockington RA
Published: January 2008

We describe the results of tracking serum lipids, and dietary intake of energy, fat and calcium in a cohort of 106 children in the Adelaide Nutrition Study who were followed to 15 years of age together with an additional 123 children recruited from 11 years of age. Measures of energy, fat and calcium intakes were obtained from analyses of 4‐day weighed records. The pattern and level of tracking were similar for males and females. The tracking coefficient for total cholesterol was 0.28‐0.49 between 1 and 15 years of age, 0.3‐0.64 between 2‐8 and 15 years of age, 0.48‐0.64 between 8‐11 and 15 years of age, 0.71‐0.78 between 11‐13 and 15 years of age and 0.71‐0.78 between 13 and 15 years of age. The pattern was similar for low density lipoprotein cholesterol, but lower for high density lipoprotein cholesterol. For mean daily energy, fat and calcium intake, tracking coefficients were low below 4 years of age, but from then on were 0.46‐0.64 for energy intake, 0.38‐0.51 for fat (g) and 0.51‐0.62 for calcium (mg).Adolescence, child, cholesterol, nutrition, tracking
Respiratory water loss in relation to gestational age in infants on their first day after birth
Authors: Riesenfeld T , Hammarlund K , Sedin G
Published: January 2008

Respiratory water loss, oxygen consumption and carbon dioxide production were measured in 32 infants on their first day after birth. Gestational age was between 27 and 41 weeks. All infants were studied in incubators with 50% ambient relative humidity and an ambient temperature that allowed the infant to maintain a normal and stable body temperature. During the measurements the infants were usually asleep. Respiratory water loss was found to be highest in the most preterm infants and lower in more mature infants. Respiratory water loss per breath (mg/kg) was almost the same at all gestational ages and the higher respiratory water loss found in the most preterm as compared with the more mature infants is thus due to a higher rate of breathing. Oxygen consumption was lowest in the most preterm infants and increased with increasing gestational age. Thus, in full‐term infants respiratory water loss and transepidermal water loss are of approximately equal magnitude at an ambient humidity of 50%, while respiratory water loss constitutes a smaller proportion than trans‐epidermal water loss in very preterm infants. Respiratory water loss increases with the rate of breathing. ? Insensible water loss, oxygen consumption, preterm infants, respiratory water loss

G Sedin, Department of Paediatrics, University Hospital, S‐751 85 Uppsala, Sweden
Subaponeurotic haemorrhage in the 1990s: a 3‐year surveillance
Authors: Ng PC , Siu YK , Lewindon PJ
Published: January 2008

A 3‐year survey of subaponeurotic haemorrhage (January 1991 to December 1993) in a tertiary referral centre in Hong Kong revealed that the incidence of this life‐threatening condition was 6.4 per 1000 ventouse‐associated deliveries, which is 60‐fold more common than with other modes of childbirth. We highlight a lesser known phenomenon of marked male predominance (male to female ratio 8:1). Three of 18 (17%) infants with subaponeurotic haemorrhage died. Severe subaponeurotic haemorrhage with a decrease in venous haematocrit > 25% of the baseline value at birth and requiring urgent blood transfusion in the first 12 h, in association with significant birth asphyxia with arterial cord blood pH < 7.20 and 1‐minApgar score3 were the most important risk factors for death. A worrying feature was the silent presentation of occult subaponeurotic haemorrhage in two of the fatal cases. Frequent monitoring of haematocrit, early and rapid restoration of blood volume and prompt commencement of cardiac inotropes are the keys to the management of this condition, which should be suspected in all ill newborn infants subjected to the ventouse applicator, Cord blood pH, haematocrit, subaponeurotic haemorrhage, ventouse

PC Ng, Department of Paediatrics, Level 6, Clinical Sciences Building, Prince of Wales Hospital, Shatin, NT, Hong Kong
Primary idiopathic hypomagnesemia in two female siblings
Authors: Challa A , Papaefstathiou I , Lapatsanis D , Tsolas O
Published: January 2008

Two female siblings with primary idiopathic hypomagnesemia, born to consanguineous parents, are described. Both presented at 6 weeks of age, with convulsions and persistent hypocalcemia (calcium 1.5 and 1.6 mmol/1; normal range (NR) 2.2‐2.6 mmol/1), which could not be controlled with anticonvulsants and/or calcium gluconate. On further investigation they were also found to have hypomagnesemia (magnesium 0.17 mmol/1 and 0.22 mmol/l; NR 0.65‐1.05 mmol/l). Convulsions and the low serum calcium and magnesium levels were first managed by im and then by oral administration of magnesium supplements. A burst in circulating parathyroid hormone levels to well above the physiological range was observed at the start of therapy. Serum magnesium values of the mother and father were just below the normal range, with normal serum calcium. This type of infantile primary hypomagnesemia appears to be a hereditary disease with autosomal recessive characteristics, although a partially penetrant X‐linked or autosomal dominant trait cannot be excluded.

Convulsions,primary hypomagnesemia
Recurrent reversible rhabdomyolysis associated with hyperthermia and status epilepticus
Authors: Sato T , Ota M , Matsuo M , Tasaki H , Miyazaki S
Published: January 2008

A 6‐year‐old boy developed rhabdomyolysis following hyperthermia and status epilepticus with a diagnosis of severe myoclonic epilepsy of infancy. At 2 and 3 years of age, he had similar episodes. Each time he recovered completely in 3‐4 weeks with conservative management, in spite of renal insufficiency and marked liver dysfunction. Several cases of recurrent myoglobinuria after intense exercise or generalized tonic‐clonic convulsions were reported to have genetic errors of carbohydrate or lipid metabolism of muscle. In our patient, however, the activity of these enzymes was found to be normal. This indicates that status epilepticus may cause recurrent rhabdomyolysis in subjects with normal glycolytic and lipolytic enzyme activity. Myoglobinuria, rhabdomyolysis, severe myoclonic epilepsy of infancy, status epilepticus
Colour Doppler myocardial imaging: potential applications in acquired and congenital heart disease
Authors: Sutherland GR
Published: January 2008

Doppler myocardial imaging (DMI) is a new ultrasound technique which has been developed to allow colour Doppler imaging of cardiac structures as opposed to blood pool imaging This is achieved by changing the velocity, filtering and threshold parameters of the standard colour Doppler algorithms DMI parameters which can be measured are regional tissue velocity, acceleration and reflected Doppler energy In addition, concomitant changes in the pulsed Doppler algorithms allow interrogation of instantaneous peak velocities during the cardiac cycle in the myocardial region in which the sample volume is placed In both adult acquired heart disease and congenital heart disease, these new ultrasound parameters may provide new information on myocardial contractile function, diastolic function, myocardial perfusion and myocardial structure The relative lack of image quality by chest wall attenuation inherent in the Doppler technique means that the methodology is potentially superior to standard grey‐scale two‐dimensional imaging in boundary detection and may prove to be of value in providing a robust boundary detection algorithm for use in volume calculations and in three‐dimensional reconstruction of ventricular function.
Lipid profiles and blood pressure: are they risk factors for the development of early background retinopathy and incipient nephropathy in children with insulin‐dependent diabetes mellitus?
Authors: Kordonouri O , Danne T , Hopfenmüller W , Enders I , Hövener G , Weber B
Published: January 2008

The objective of this study is to examine the influence of lipid profiles and blood pressure on the development of microvascular complications in adolescents with insulin‐dependent diabetes mellitus (IDDM) in a matched pairs study. Patients with early background retinopathy (n= 21) or microalbuminuria (n= 15) and their respective statistical twins participated in the study. Serum total cholesterol, high‐density lipoprotein (HDL) cholesterol, fasting triglycerides, glycosylated haemoglobin Alc (Hb Alc.), and systolic and diastolic blood pressure during 3 years prior to the development of early background retinopathy or incipient nephropathy were examined. The multivariate discriminant analysis demonstrated glycaemic control and HDL cholesterol to be the most important variables related to the development of retinal lesions (84% correctness), and diastolic blood pressure to be associated with microalbuminuria (57% correctness). In addition to poor glycaemic control, different factors seem to be important for the early retinal or renal lesions of juvenile IDDM.
Regional skin temperature, heat flow and conductance in preterm neonates nursed in low and in neutral environmental temperature
Authors: Karlsson H , Oleåird R , Nilsson K
Published: January 2008

The changes of regional dry heat loss and skin temperature in 15 healthy preterm babies, 8 with a gestational age (GA) of 33–36 weeks and 7 with a GA of 28–31 weeks, were studied under controlled conditions at environmental temperatures ranging from 29.5 to 34.0°C. In both groups of babies the skin temperature for all body regions followed the changes in operative temperatures. Regional dry heat losses also closely followed the external temperature gradient. In the 33–36 weeks GA neonates the regional changes in thermal conductance (index of cutaneous blood flow) indicated that only the foot responded to low environmental temperature with vasoconstriction while vasodilatation was indicated for the trunk. in the 28–31 weeks GA neonates similar but not significant changes of thermal conductance were calculated. The limited ability to reduce heat loss by reducing the skin conductance over a major part of the body surface area contributes to the vulnerability to low environmental temperature in preterm neonates.
Diagnosis and treatment of a child with the syndrome of apparent mineralocorticoid excess type 1
Authors: Miiller‐Berghaus J , Homoki J , Michalk DV , Querfeld U
Published: January 2008

We report the case of a 16‐month‐old boy who presented with chronic vomiting, failure to thrive, arterial hypertension and medullary nephrocalcinosis. Laboratory results revealed hypokulaeniin. metabolic alkalosis, increased urinary potassium excretion and ii hyporeninaeniic hypo~ildostei‐onisiii. Chromatographic determination of urinary steroid metabolites showed a n abnormal elevation of tetrahydi‐ocortisol and do‐tetrahydrocortisol compared to tetrahydrocortisone; this pattern of urin‐ ary steroid excretion is essential for the diagnosis of the syndrome of apparcnt mineralocorticoid excess type I and believed to be a result of the underlying metabolic defect, a decreased activity of the II & hydroxysteroid dehydrogenase. A second variant, called syndrome of apparent mineralocorticoid excess type 2, has similiar clinical features but lacks the typical urinary steroid profile. Therapy with spironolaetone resulted in growth, weight gain and blood pressure control.
Breastfeeding, smoking and the presence of the child's father in the household
Authors: Eriksen W
Published: January 2008

The breastfeeding practice of 312 mothers attending mother and child health centres in Oslo, Norway, was measured using self‐administered questionnaires. Having started with supplements at 3 months postpartum was related to having a spouse/cohabitant, smoking, and having only one child (logistic‐regression with civil state, age, education, smoking, number of children, social support, smoking × civil state, and education × civil state as independent variables). The frequency of having started with supplements increased with increasing maternal cigarette consumption. Among non‐smoking, married/cohabiting mothers, the frequency of having started with supplements at 3 months postpartum was 41% if the spouse/cohabitant smoked, compared with 18% if he did not smoke (p < 0.01).
Alport's syndrome in 78 patients: epidemiological and clinical study
Authors: Pajari H , Kääriäinen H , Muhonen T , Koskimies O
Published: January 2008

In a nationwide study in Finland, 78 patients, 38 male and 40 female in 25 families, were found to have Alport's syndrome, corresponding to 1 in 53 000 live births. This frequency of clinically manifest Alport's syndrome was much lower than expected from earlier reports. The first sign of the disease was most often haematuria, but was sometimes proteinuria or hearing loss. These signs were detected at a similar median age in both boys and girls, namely 6.2 and 6.0 years, respectively. The patients were followed up over a median period of 12.1 years (range 0.1‐34.0 years). The clinical course of the disease was more severe in the male subjects than in the female subjects: 53% of the males and 13% of the females developed terminal renal failure at median ages of 24.9 and 31.1 years, respectively. At the last observation, 34% males and 78% females were free of renal insufficiency at median ages of 10.3 and 26.8 years. Hearing loss was detected in 74% of the males and 5% of the females. Regarding the rate of deterioration of renal function, no statistically significant difference was noticed between males and females. The routine use of dialysis and transplantations has dramatically changed the life expectancy of the patients.
Intravenous immune globulin in neonatal immune hemolytic disease: does it reduce hemolysis?
Authors: Hammerman C , Vreman HJ , Kaplan M , Stevenson DK
Published: January 2008

We studied the effect of intravenous immune globulin (IVIG) on hemolysis in term, hyperbilirubinemia, Coombs’positive infants utilizing measurement of carboxyhemoglobin fraction corrected for inhaled carbon monoxide (COHbc), a sensitive indicator of hemolysis. COHbc values were determined before and after IVIG infusion. In those babies who responded with a decrease in serum total bilirubin (n= 19). no exchange transfusions were required and COHbc levels decreased significantly by 24 h post‐IVIG from 1.37 ± 0.31 to 1.12 ± 0.26% tHb (p< 0.0001). There were no corresponding decreases in COHbc levels (1.89 ± 0.54 to 1.82 ± 0.48% tHb; (p> 0.05) among those whose serum bilirubin levels did not decrease in response to IVIG (n= 7), and all of these infants required exchange transfusions. Furthermore, the extent of the decrease in COHbc was related to the degree of decrease in serum bilirubin levels, such that the percentage decrease of bilirubin at 24 h was directly correlated with the percentage decrease of COHbc at 24 h (p= 0.007). We conclude that IVIG, when successful, inhibits hemolysis in these infants.
Normalization of cellular zinc levels in patients with Down's syndrome does not always correct low thymulin levels
Authors: Brigino EN , Good RA , Koutsonikolis A , Day NK , Kornfeld SJ
Published: January 2008

Retrospective analysis of five Down's syndrome (DS) patients who presented with recurrent infection revealed that all had initial low thymulin levels. Three patients had low cellular zinc levels that normalized after zinc replacement. Contrary to previous studies, thymulin levels were persistently low in four of five DS patients despite maintaining or achieving normal cellular zinc levels. A primary thymic epithelial defect may be responsible for the persistent thymulin deficiency in DS patients.
Hepatic haemangioendothelioma presenting with early heart failure in a newborn: treatment with hepatic artery embolization and interferon
Authors: Fok TF , Chan MSY , Metreweli C , Ng PC , Yeung CK , Li AKC
Published: January 2008

We report our management of a newborn presenting in utero with congestive heart failure secondary to a giant hepatic haemangioendothelioma. Control of heart failure was achieved by transcalheter hepatic artery embolization, and rapid regression of the tumour was observed after a course of α1 interferon. The combination of hepatic artery embolization and interferon may be a useful approach in the management of this rare, potentially fatal condition.
Growth hormone status in six children with fetal alcohol syndrome
Authors: Hellström A , Jansson C , Boguszewski M , Olegård R , Laegreid L , Albertsson‐Wikland K
Published: January 2008

Objective:Prenatal alcohol exposure may cause fetal alcohol syndrome (FAS), which is associated with pre‐ and postnatal growth retardation. Materials and methods: Spontaneous 24‐h growth hormone (GH) secretion was measured in six prepubertal short children with FAS (two boys and four girls) aged 4‐14 years. The response to a GH stimulation test, and levels of insulin‐like growth factor‐I (IGF‐1) and IGF‐binding protein‐3 (IGFBP‐3) were also measured. Comparisons were made between the children with FAS and healthy children of both normal and short stature, as well as children born small for gestational age (SGA). Results: There were no differences in the mean area under the curve above the baseline or the maximum level of GH during a 24‐h period (GHmax) between the children with FAS and the reference groups. However, the estimated rate of spontaneous 24‐h GH secretion in children with FAS was similar to that of children born SGA, but lower than in children of normal stature (p= 0.02). The plasma concentrations of IGF‐1 and IGFBP‐3 were in the lower parts of the normal range. Conclusion: We conclude that GH secretion in short children with FAS is similar to that in short children born SGA; that is, in the lower range of normal children.
Studies on nutrition in severely neurologically disabled children in an institution
Authors: Hals J , Ek J , Svalastog AG , Nilsen H
Published: January 2008

Severe neurological handicaps in children are frequently accompanied by growth retardation. We have studied 13 severely neurologically impaired children in an institution to see if their poor growth was related to a low intake of energy and nutrients, if this was reflected in biochemical nutritional parameters, and to modify their diet according to the results. The investigation showed low dietary intakes of energy and of several of the nutrients, with corresponding low Hb values and serum values of ferritin, selenium and vitamins E and D in some of the children. All the children were initially light for age, with catch‐up growth after intervention. We conclude that severely disabled children are at high risk for under‐ and malnutrition, and that this may partly explain the growth retardation in the study group. To avoid the potential detrimental effects of malnutrition, it is important to aim at providing an optimal diet.
Breastfeeding pattern in a population with different levels of poverty in Southern Brazil
Authors: Giugliani E , Issler R , Kreutz G , Meneses C , Justo E , Kreutz V , Pires M
Published: January 2008

A cross‐sectional study was conducted on 477 poor children aged 12–59 months in order to investigate their breastfeeding pattern, taking into account the poverty level of their families. Although the population living in extreme poverty had the same pattern of breastfeeding as the rest of the poor population, the former group should still have priority in breastfeeding promotion programs, since they are the population who benefit most with breastfeeding.
MxA protein in infants and children with respiratory tract infection
Authors: Forster J , Schweizer M , Schumacher RF , Kaufmehl K , Lob S
Published: January 2008

MxA protein—a stable product of cells stimulated by type I interferons—was examined prospectively for its ability to discriminate between viral and bacterial respiratory tract infections (RTIs) in 182 infants and children. The nasopharyngeal secretions (NPSs) of all of them were tested for MxA using enzyme‐linked immunosorbent assay (ELISA), and the whole blood of 92. Seventy‐three children undergoing elective surgery served as controls. These apparently healthy children had higher levels of serum MxA than adult controls. Using antigen detection and serology, a viral aetiology was diagnosed in 81/182 cases. The sensitivity and specificity of MxA ELISA were assessed at 92 and 76% for the blood test and at 40 and 91% for the NPS, respectively. The positive predictive value for a viral RTI was superior to a leucocyte count or C‐reactive protein when determined only once.
Asthma treatment in schoolchildren: lung function in different therapeutic groups
Authors: Korppi M , Remes K
Published: January 2008

Dynamic spirometry and peak expiratory flow were measured in 297 school‐aged children with asthma during their control visit at the outpatient clinic in 1993. Sixty (20%) children had no maintenance drugs, 169 (57%) used cromoglycate (n= 97) or nedocromil (n= 72), and 68 (23%) budesonide. The treatment of each child had been selected on clinical grounds according to the principles of the international consensus statement from 1989. The mean values of peak expiratory flow (PEF), forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1) were over 95% of the height‐related reference values in all treatment groups. The lower limits of the 95% confidence intervals were at the level of more than 90% of those predicted. The mean FEV1/FVC ratio (FEV%) was over 85%, and the mean maximal mid‐expiratory flow (MMEF) over 75% of the reference values. Decreased PEF values (<75%) were present in 10%, decreased FVC, FEV1, or FEV% (<75%) values in 4–6%, and decreased MMEF ((65%) values in 18%. Only minor differences between the different therapeutic groups were observed. Our results show that the clinical selection of children between the three therapeutical groups was adequate. In our area up to 70% of children requiring maintenance therapy for asthma can be treated with cromones.
Diagnosis of the Prader‐Willi syndrome by proving the absence of the unmethylated PW71 DNA fragment
Authors: Lindgren AC , Grandell U , Ritzén EM , Anvret M
Published: January 2008

The Prader‐Willi syndrome (PWS) is a genetic disorder which is difficult to diagnose from clinical symptoms in newborns and young children. However, it is known that in PWS a fragment within the q11‐13 region of the paternally derived chromosome 15 is deleted. Recently it has been observed that the D15S63 (PW71) locus in chromosome 15q11‐13 is methylated on the maternally derived chromosome, but unmethylated on the paternally derived chromosome. Based on this observation a rapid diagnostic test (the PW71 methylation test) using methylation‐sensitive restriction enzymes has been developed for patients presumed to have PWS. We have studied 56 patients; 30 patients with classical features of PWS and 26 patients with only psychomotor retardation and obesity, referred to us from different parts of Sweden. Twenty‐nine of the 30 classical PWS patients were found to have an absence of the unmethylated paternally derived PW71(D15S63) locus in chromosome 15q11‐13. None of the patients with only obesity and psychomotor retardation had this “absence” pattern on chromosome 15q11‐13. Using the PW71 methylation test on patients with PWS, a concordance of 96% was found. The PW71 methylation test is presently the method of choice for rapid diagnostic testing of patients suspected of having PWS.
Influence of plasma preparations and donor red blood cells on the antioxidant capacity of blood from newborn babies: an in vitro study
Authors: Moison RMW , van Hoof EJHA , Clahsen PC , van Zoeren‐Grobben D , Berger HM
Published: January 2008

We investigated in an in vitro transfusion model the early effects of plasma preparations and donor red blood cells on the antioxidant capacity of the cord blood from babies. Addition of pasteurized plasma protein solution to plasma from babies decreased the peroxyl radical trapping capacity (p <0.02). In contrast, fresh frozen plasma did not lower this capacity. Addition of adult donor red blood cells to the babies' red blood cells did not significantly decrease the glutathione‐recycling capacity of the blood. On the basis of these in vitro results we hypothesize that the use of resuscitation fluids with low antioxidant capacity may temporarily decrease the ability of the baby to catabolize reactive oxygen species.
Physiological anticoagulants and activated protein C resistance in childhood stroke
Authors: Riikonen RS , Vahtera EM , Kekomäki RM
Published: January 2008

Immunological and functional protein S, protein C and antithrombin III levels and anticoagulant responses to activated protein C were measured in 24 patients with stroke in childhood. No hereditary deficiencies were found. The protein S levels in healthy controls of younger age did not differ from the adult levels. For optimal screening of protein S deficiency, measurements using functional as well as immunological assays are recommended. Appropriate criteria for the diagnosis of the deficiencies must be carefully applied if unnecessary anxiety and inappropriate treatment of children are to be avoided.
Aortic thrombosis in a neonate with hereditary antithrombin III deficiency: successful outcome with thrombolytic and replacement treatment
Authors: Sánchez J , Velasco F , Alvarez R , Roman J , Torres A
Published: January 2008

We report the case of a newborn male who presented an aortic thrombosis during the neonatal period and was subsequently diagnosed as having antithrombin III (AT III) hereditary deficiency type I. This hypercoagulable condition is known to predispose young adults to venous thrombosis, but in our patient the primary thrombotic incident affected the arterial vessels within the first few days of life. Combined treatment with thrombolytic agents and AT III concentrates recovered aortic permeability, suggesting that the use of AT III may be beneficial for the treatment of thrombotic complications during the first few days of life.
Xanthogranulomatous pyelonephritis—an unusual renal disease in childhood
Authors: Esbjörner E , Andersson T , Hussein A , Windahl T
Published: January 2008

We report on a 6‐year‐old boy with Xanthogranulomatous pyelonephritis. This unusual type of renal inflammation has a typical clinical picture that is important to bear in mind. The affected child is often seriously ill with a palpable flank mass leading to initial suspicion of malignancy. Modern imaging procedures help in obtaining a pre‐operative diagnosis.
The impact of phototherapy in the management of neonatal hyperbilirubinemia: comparison of historical cohorts
Authors: Valaes T , Koliopoulos C , Koltsidopoulos A
Published: January 2008

To quantitatively assess the impact of phototherapy (PT) in the prevention of kernicterus we calculated the rate of exchange transfusion (ET) in two large historical cohorts of Greek neonates (birthweight ≥2.5 kg), one before (period I: 1957–61) and one after (period II: 1980–92) the introduction of PT. Overall, the introduction of PT was associated with a reduction of the rate of ET from 0.43% in period I to 0.05% in period II. The reduction was observed in all etiological categories but was more marked in the ABO‐incompatible group. With an estimated rate of kernicterus without treatment of 0.085% (excluding rhesus hemolytic disease of the newborn and prematurity) we estimated that 4.2 and 0.36 infants were treated by ET for each spared kernicterus in periods I and II, respectively. Finally, in period II 185 infants were treated with PT or PT and ET for each spared kernicterus.
A potential danger of bedclothes covering the face
Authors: Campbell AJ , Bolton DPG , Williams SM , Taylor BJ
Published: January 2008

Investigations of infants dying unexpectedly have reported up to 28% being found completely under bedding. No detailed physiological studies looking at the possibilities of asphyxia in this situation are available. The aim was to determine the potential for asphyxia under different types and thicknesses of bedding. A mechanical model of a 3‐month‐old infant's respiratory system was used. Bedding was positioned over the head in a supine position, and inspired carbon dioxide recorded. With a fixed respiratory rate and tidal volume, carbon dioxide accumulation increased with increasing layers of blankets. Up to 8.3% inspired carbon dioxide was recorded with more than four layers of blankets. A cotton sheet between the face and blankets reduced the accumulation by half. An infant found dead under bedding may have been exposed to an asphyxial stress. Suffocation from rebreathing trapped, expired gases can be a cause of death in this situation.
Parvovirus B19 infection and Diamond‐Blackfan anaemia
Authors: Heegaard ED , Hale H , Clausen N , Hornsleth A , Kerndrup GB
Published: January 2008

It is the purpose of the study to report the frequency of parvovirus in children with a diagnosis of Diamond‐Blackfan anaemia and to discuss the possible aetiological role of parvovirus in Diamond‐Blackfan anaemia. We found parvovirus DNA in 3 of 11 bone marrow smears. Giant pronormoblasts showed low sensitivity (33%) and poor specificity (75%). The presence of giant pronormoblasts was associated with a very high myeloid: erythroid ratio, and may not be specific for parvovirus infection, but a feature of severely suppressed erythropoiesis. The three parvovirus‐positive patients were the only children who experienced a remission, and who are free of medication. The seven surviving parvovirus‐negative patients are all currently on steroid treatment.
Outcome of idiopathic membranoproliferative glomerulonephritis in children
Authors: Schwertz R , de Jong R , Gretz N , Kirschfink M , Anders D , Schärer K ,   Arbeitsgemcinschaft Pädiatrische Nephrologie
Published: January 2008

The aim of this multicentre study was to analyse the long‐term outcome of idiopathic membranoproliferative glomerulonephritis (MPGN) according to histological type and to the presence of C3 nephritic factor. Fifty patients aged 2 14 years at the onset of the study were followed over 2 20 years; 26 patients had MPGN type I, 17 had type II and 7 had type III. Treatment was variable. At the last observation, 30 patients had reached terminal and four pre‐terminal renal failure. The median survival probability until renal death was 15.3, 8.7 and 15.9 years for disease types I, II and III respectively (difference between MPGN types I + III versus type II: p= 0.013). The presence of an initial nephrotic syndrome was associated with a more rapid progression (p= 0.018). C3 nephritic factor was of no prognostic value. We conclude that the outcome of MPGN mainly depends on the histological type observed.
A regression method including chronological and bone age for predicting final height in Turner's syndrome, with a comparison of existing methods
Authors: Teunenbroek A van , Stijnen Th , Otten B , Keizer‐Schrama S de Muinck , Naeraa RW , Rongen‐Westerlaken C , Drop S
Published: January 2008

A total of 235 measurement points of 57 Dutch women with Turner's syndrome (TS), including women with spontaneous menarche and oestrogen treatment, served to develop a new Turner‐specific final height (FH) prediction method (PTS). Analogous to the Tanner and Whitehouse mark 2 method (TW) for normal children, smoothed regression coefficients are tabulated for PTS for height (H), chronological age (CA) and bone age (BA), both TW RUS and Greulich and Pyle (GP). Comparison between all methods on 40 measurement points of 21 Danish TS women showed small mean prediction errors (predicted minus observed FH) and corresponding standard deviation (ESD) of both PTSRUS and PTSGP, in particular at the “younger” ages. Comparison between existing methods on the Dutch data indicated a tendency to overpredict FH. Before the CA of 9 years the mean prediction errors of the Bayley and Pinneau and TW methods were markedly higher compared with the other methods. Overall, the simplest methods—projected height (PAH) and its modification (mPAH)—were remarkably good at most ages. Although the validity of PTSRUS and PTSGP remains to be tested below the age of 6 years, both gave small mean prediction errors and a high accuracy. FH prediction in TS is important in the consideration of growth‐promoting therapy or in the evaluation of its effects.
Magnetic resonance imaging and neurological evaluation after treatment with high‐dose methotrexate for acute lymphocytic leukaemia in young children
Authors: Seidel H , Nygaard R , Haave I , Moe PJ
Published: January 2008

This study evaluates the occurrence of permanent cerebral white matter changes and neurological abnormalities in children treated at a young age for acute lymphocytic leukaemia. Our pilot treatment protocol did not include central nervous system irradiation, but intrathecal methotrexate and high‐dose methotrexate infusions followed by very intensive folinic acid rescue. We examined 12 children in complete remission and off therapy 18 months to 9.5 years after their last methotrexate infusion. They were below 5 years of age at diagnosis and therefore expected to be at special risk of neurotoxic sequelae. Cerebral magnetic resonance imaging in the 11 cases thus evaluated did not reveal white matter abnormalities or other signal changes as signs of permanent treatment‐related sequelae. We did not observe any pathological clinical neurological findings likely due to methotrexate.
Irregular breathing in young lambs and newborn infants during heat stress
Authors: Riesenfeld T , Hammarlund K , Norsted T , Sedin G
Published: January 2008

Ten healthy unanaesthetized full‐term lambs, aged 4‐12 days, were studied during moderate radiant heat stress, and 21 full‐term newborn infants were studied during moderate convective heat stress. The rate of breathing and the breathing pattern were recorded, using strain gauges made of mercury‐filled rubber tubing placed around the thorax and abdomen. In both the lambs and the infants the respiratory rate increased during heat stress. When this increase began, both the lambs and infants had short periods of very rapid breathing followed by short apnoeas. The concentrations of carbon dioxide and water in a flow‐through system collecting expired air increased during the short periods of rapid breathing and then decreased again during the subsequent short apnoeic period.
Temporary intrathoracic adenopathy in children—a response to infection caused by non‐tuberculous mycobacteria?
Authors: Larsson LO , Berg‐Kelly K
Published: January 2008

Two children, 4 and 8 years old, were skin tested with sensitins and found to have indurations of 20 nun. Sensitins are tuberculins deriving from non‐tuberculous mycobacteria. The children showed pathological enlargement of mediastinum on chest radiography. They were further examined, and no findings supported malignancy nor tuberculosis. The chest radiographs were normalizing within a few months. The large sensitin reactions together with the other findings indicate that the children had been infected with non‐tuberculous mycobacteria.