bluuebunny/crossref_metadata_2025 huggingface dataset:
Why do parents hesitate to vaccinate their children against measles, mumps and rubella?
Authors: Alfredsson R , Svensson E , Trollfors B , Borres MP
Published: August 2010

Background: Thanks to a successful voluntary vaccination programme, measles, mumps and rubella are rare diseases in Sweden. Coverage among children 18 mo of age has been 99%, but the measles, mumps and rubella vaccination (MMR) has increasingly been questioned among parents. Aim: To study reasons why parents choose not to vaccinate their child against measles, mumps and rubella, and their opinions on vaccines and the diseases themselves. A secondary objective was to compare coverage at 18 mo of age based on parental report with the national statistics based on patient charts. Methods: The official statistics were compared with patient charts for two birth cohorts in the city of Göteborg, Sweden. Out of these children born in 1995 and 1996, 300 unvaccinated and vaccinated children were identified. Their parents received a postal questionnaire assessing the parent's views on vaccines and childhood diseases. Results: The documented vaccine coverage in this study was higher in 1995 and 1996 than official statistics indicated. The major reason, for both groups, for accepting respectively declining vaccination was strengthening the child's immune system. Parents with children unvaccinated against MMR were also more likely to have declined vaccination against diphtheria, polio, tetanus, Haemophilus influenzae and pertussis. One‐third of the parents with a child unvaccinated against MMR had not yet made their final decision 3 y after the vaccine offer. Few parents, both with vaccinated and unvaccinated children, had acquired vaccine information from the Internet. Both groups believed that insufficient time was allocated for vaccine information and discussion at the Child Health Centre.

Conclusion: Our study indicates that official statistics on MMR vaccination uptake underestimate the number of vaccinated children. Vaccine safety is a major concern for many parents and needs to be addressed by healthcare professionals at institutions offering paediatric vaccinations.
Children conceived after intracytoplasmic sperm injection (ICSI): is there a role for the paediatrician?
Authors: Mau C , Juul A , Main KM , Loft A
Published: August 2010

Aim: The aim of the study was to evaluate current medical knowledge about children born after intracytoplasmic sperm injection (ICSI) with respect to congenital malformations, chromosome abnormalities and postnatal growth. Results: The total malformation rate in children conceived after ICSI was comparable to the background population in nine of the 11 articles studied. In two of the studies, a significant increase in congenital malformations was found. More specifically, children born after ICSI appear to have a higher risk of urogenital malformations, especially hypospadias, which may be related to paternal subfertility. There is insufficient knowledge about chromosomal or genetic anomalies and auxological data in children born after ICSI. The methodological approach to follow‐up the children was inconsistent, as the clinical examinations were not done with standardized ascertainment.

Conclusion: Paediatricians and obstetricians should collaborate with fertility clinics to obtain valid longitudinal observations with respect to congenital malformations, neurological development, growth, pubertal maturation, fertility and morbidity in children conceived by ICSI.
Rehospitalization of very preterm infants
Authors: Kollée LAA
Published: August 2010

Rehospitalization rates of very preterm infants because of reasons that are related to neonatal morbidity states can be decreased with further improvement of neonatal intensive care provided.

Conclusion: Analysis of rehospitalization data should be included in follow‐up programmes as a contribution to the development of strategies to improve neonatal care and the ultimate outcome for very‐low‐birthweight infants.
A cohort study of term infants from Vilnius, Lithuania: feeding patterns
Authors: Vingraite J , Bartkeviciute R , Michaelsen KF
Published: August 2010

Aim: To present infant feeding patterns and to relate these to selected biological and social factors. Methods: One hundred and ninety‐two infants born at four delivery departments were followed prospectively from birth to 12 mo of age. Their parents were asked to tick weekly if the infant received items on a list of the most common infant foods and drinks, including breast milk. Results: All infants started breastfeeding. Median duration of exclusive breastfeeding was 0.5 mo, and 3.75 mo for “any breastfeeding”. Mothers who were older (>25y), better educated (>11 y) and non‐smokers breastfed significantly longer (median 4 mo). Median introduction of cow's milk was 8 (range 2–12) mo. At the age of 12 mo, 78% of infants received cow's milk and 58% of infants received cow's milk as the sole source of milk. Mothers who were younger (<21 y) and less educated (<12y) introduced cow's milk significantly earlier. Mean (SD) start of solids was 3.4 (1.0) mo. Longer duration of breastfeeding was the only factor significantly associated with the later start of solids. Ninety‐two percent of infants were introduced to fresh cheese before 12 mo. Additional liquids were widely given both to breastfed and non‐breastfed infants.

Conclusions: Compliance with the current infant feeding recommendations is not sufficient. Breastfeeding rates are low. Use of high‐protein products is widespread. More effort should be made to educate young, less educated and smoking mothers.
Impulse control, working memory and other executive functions in preterm children when starting school
Authors: Böhm B , Smedler A‐C , Forssberg H
Published: August 2010

Aim: The aim of this study was to explore whether children born preterm have deficient executive functions (EF) in comparison with children born at full term, and, if so, whether this is dependent on inferior intelligence scores and can be correlated to specific neonatal risk factors and gender.Methods: In a population‐based study, the executive functions of 182 preterm children (birthweight less than 1500 g, VLBW) and 125 controls from the Stockholm Neonatal Project were assessed at 5± y with a neuropsychological test battery (Nepsy 1990).Results: The controls surpassed the VLBW children on tests of executive functions (EF), even after controlling for intelligence (IQ); a necessary correction since there were significant correlations between measures of EF and IQ. EF was associated with retinopathy of prematurity (ROP), and with visual impairment as a whole. In both groups, girls surpassed boys on tests of executive functions.

Conclusion: We conclude that it is possible to analyse executive functions already at preschool age. Preterm children are at risk of having subnormal levels of executive functioning, even though their general IQ is normal.
Factors of early infancy and recurrent use of antibiotic therapy
Authors: Louhi‐Pirkanniemi K , Rautava P , Aromaa M , Ojanlatva A , Mertsola J , Helenius H , Sillanpää M
Published: August 2010

Aim: To analyse the role of early infant‐related, parent‐related, family functioning and social relation factors during the infant's first 3 mo of life and their associations with later recurrent treatments with antibiotics. Methods: In an unselected population‐based study, parents expecting their first child were followed from pregnancy until the infant was 18 mo of age. Informed consent to participate was obtained from 1443 women expecting their first child and their spouses. The parents of 817 children reported the number of preceding antibiotic treatments at two times (when the child was 9 and 18 mo old). The outcome measure was the number of antibiotic treatments (options: none, 1–5, ±6). The factors associated with later use of antibiotics were collected during the first 3 mo of the infant's life. The variable factors included infant‐related, parent‐related, family functioning and social relation factors. Results: The final regression analysis showed the potent factors associated with recurrent use of antibiotics: male gender (OR 2.8, 95% CI: 1.6–4.8), frequent physician consultations in early infancy (OR 3.1, 95% CI: 1.8–5.3) and the father's need for outside support (OR 2.2, 95% CI: 1.3–3.8).

Conclusions: In addition to early infant‐related medical factors, family factors may be associated with frequent medical consultations and the decision to administer antibiotics to the infant. In the prevention of antibiotic overuse, social and psychological factors should be considered.
Respiratory outcome in school‐aged, very‐low‐birth‐weight children in the surfactant era
Authors: Korhonen P , Laitinen J , HyoUdynmaa E , Tammela O
Published: August 2010

Aim. To assess respiratory outcome and its predictors during the surfactant era in very‐low‐birth‐weight (VLBW, birth weight <1500g) schoolchildren with and without bronchopulmonary dysplasia (BPD). Methods. At 7‐8 years of age, 34 VLBW children with BPD diagnosed at a postnatal age of 28 d underwent flow‐volume spirometry, metacholine challenge, bronchodilatation test, whole body plethysmography and diffusion capacity measurement. Fourteen of them had not recovered from BPD by a corrected gestational age of 36 wk (sBPD subgroup). The age‐ and sex‐matched control groups comprised 34 VLBW cases without BPD and 34 term children. Results. Current respiratory symptoms in contact with cold air and/or upon exercise were reported in one‐third of the VLBW children. Only half of the symptomatic VLBW cases without BPD had inhaled medications. Compared with term controls, the BPD cases had lower forced expiratory volume in 1 s (FEV1), higher ratio of residual volume to total lung capacity and higher airway resistance. Lower FEV1 and specific conductance were found in the sBPD subgroup compared to both control groups. Additionally, their vital capacity was lower than in term controls. A higher rate of bronchial hyper‐reactivity and lower diffusion capacity of the lungs were detected in VLBW as against term cases. Low birth weight, long duration of oxygen therapy, low socio‐economic status and exposure to animal dander emerged as predictors of poorer respiratory outcome.

Conclusion. In the surfactant era, birth weight, neonatal respiratory morbidity, as well as later environmental factors appear to affect the respiratory outcome of VLBW children. However, careful pulmonary follow‐up of all VLBW children seems to be indicated regardless of the severity of neonatal respiratory problems.
Cytokines in the gastric mucosa of children with Helicobacter pylori infection
Authors: Shimizu T , Haruna H , Ohtsuka Y , Kaneko K , Gupta R , Yamashiro Y
Published: August 2010

Aim: Few studies have looked at the cytokine profile in gastric mucosa in children with Helicobacter pylori infection. This study investigated cytokines and their effects on histological abnormalities in the gastric mucosa of children with H. pylori infection. Methods: The levels of interferon‐γ (IFN‐γ), interleukin‐4 (IL‐4) and IL‐8 proteins were measured in biopsy specimens from the gastric antrum and corpus of children with H. pylori infection, and related to inflammatory cell infiltrations. Results: The antral and corporal mucosal levels of IFN‐γ and IL‐8 proteins were significantly higher in children with H. pylori infection than in uninfected children, but there was no such difference in the levels of IL‐4 protein. The antral mucosal level of IL‐8 protein was significantly higher than the corporal mucosal level of IL‐8 protein in the infected children. Inflammatory cell infiltration was significantly higher in the infected children than in the uninfected children, but there were no significant correlations between mucosal cytokine levels and inflammatory cell infiltrations.

Conclusion: The results suggest that the predominant Th1 cytokine response and enhanced IL‐8 production in the mucosa may be involved in the gastric inflammation seen in children infected with H. pylori, as well as in adult patients.
Association between low Apgar score and neonatal cholestasis
Authors: Fischler B , Pettersson M , Hjern A , Nemeth A
Published: August 2010

Aim: To investigate the association between low Apgar score and the development of cholestasis. Methods: Seventy‐seven cholestatic infants, all referred to our tertiary centre and born between 1987 and 1996 were studied. Twenty‐eight patients had biliary atresia (BA), 36 had various intra‐hepatic disorders and for 13 patients the aetiology of the cholestasis was unknown. Data on gestational age, mode of delivery, Apgar score and birthweight for the cholestatic infants and 1 118 270 control subjects born during the same time period were obtained from the Swedish Medical Birth Registry. If the Apgar score of the cholestatic patient was <7 at 1 min and/or <9 at 5 min and/or <9 at 10 min of age the available medical records were reviewed for signs of neonatal distress. Results: Five cholestatic patients, all of them premature, fulfilled the Apgar criteria. For two of them the low Apgar score and need for immediate resuscitation were explained by major surgical problems. The other three patients, two with biliary atresia (BA) and one with Alagille syndrome, had clinical signs of neonatal distress. The incidence of low Apgar score in BA patients was 7% and in cholestatic patients without known aetiology 0%, neither figure differing significantly from that of the of the control group (2.6 %).

Conclusion: Low Apgar score is not more common in any of the cholestatic groups than in the general Swedish population of newborns. We suggest that aetiological associations other than low Apgar score need to be considered in infants with cholestasis of unknown cause.
Human immunodeficiency virus infection, diarrheal disease and sociodemographic predictors of child growth
Authors: Villamor E , Fataki MR , Bosch RJ , Mbise RL , Fawzi WW
Published: August 2010

Aim: To compare growth patterns between human immunodeficiency virus (HIV)‐infected and ‐uninfected preschool children. To examine the associations between diarrheal and respiratory infections, sociodemographic factors and growth. Methods: A longitudinal study was conducted among 524 children who were 6‐60 mo of age at recruitment. Information on sociodemographic characteristics was collected at baseline from the caregiver. Hemoglobin, malaria infection and HIV status of the children were assessed from a blood sample. Monthly height (length if >24 mo) and weight measurements were obtained, and clinical assessments carried out, during an average 12 mo follow‐up period. Yearly increments in height and weight were compared by HIV status, incidence of diarrhea and respiratory infections, and levels of sociodemographic variables. Results: After adjusting for maternal education, anemia and vitamin A supplementation, HIV infection was related to 2.8 cm [95% confidence interval (95% CI) 0.6, 5.0] and 1.3 kg (95% CI 0.0, 2.5) lower yearly length and weight gains, respectively, in children who were between 6 and 11 mo old at baseline. Among children who were 12‐23 mo old at recruitment, HIV infection was associated with 0.6 kg (95% CI 0.1, 1.0) less yearly weight gain. HIV infection was not related to linear or ponderal growth in children ≤24 mo old. Maternal illiteracy, severe child anemia and episodes of acute diarrhea were additional risk factors for growth delay in length.

Conclusion: HIV infection is associated with linear and ponderal growth retardation in children aged >24 mo. Additional predictors of linear growth retardation include preventable conditions such as poor maternal education, child anemia and diarrheal disease.
Physical activity level and body mass index among schoolchildren in south‐eastern Sweden
Authors: Raustorp A , Pangrazi RP , Ståhle A
Published: August 2010

Aim: The aims of this study were to identify current levels of physical activity and to study the relationship between physical activity and body mass index (BMI) using international cut‐off points. Methods: 871 children, aged 7–14 y, were measured for height and weight and the activity levels were analysed using pedometers to measure mean step counts for 4 consecutive days. Results: Step counts were significantly higher in boys than in girls, and showed stability over age and large in‐group differences. BMI showed that 13.2% of the boys and 14.5% of the girls were overweight and 4.5% of both boys and girls were obese. Analysis of step counts and BMIs for boys and girls revealed no significant correlations in any age group.

Conclusion: Pedometers differentiate among age groups and gender concerning physical activity and facilitate individual goal‐setting. The result of this study provide baseline information, useful as reference data, on youth physical activity as daily step counts, as well as on youth BMI levels according to new international cut‐off points.
Megestrol acetate promotes euglycemia and appetite in a child with persistent hyperinsulinemic hypoglycemia of infancy
Authors: Alyaarubi S , Ramsay M , Rodd C
Published: August 2010

This report describes a successful treatment with megestrol acetate in a child with persistent hyperinsulinemic hypoglycemia of infancy (PHHI). An 8‐y‐old child with PHHI treated with octreotide had marked impairment of appetite sensation and feeding skills. Within 3 wk of starting megestrol acetate (8 mg/kg/d) to stimulate her appetite, she had a significant improvement. By 1 y postinitiation, she had acquired age‐appropriate eating habits. The megestrol acetate caused hyperglycemia, necessitating the discontinuation of all other therapy for her hypoglycemia. Her height growth remained normal but she was found to have asymptomatic adrenal suppression.

Conclusion: Megestrol acetate appeared to stimulate appetite and regulate glucose homeostasis in this child with PHHI. Additional studies will be required to document its efficacy and safety in other children with this disorder.
Iron status in a group of Norwegian children aged 6–24 months
Authors: Hay G , Sandstad B , Whitelaw A , Borch‐Iohnsen B
Published: August 2010

An adequate iron status is of vital importance for health and development in infancy and early childhood. Iron status was evaluated in a group of full‐term Norwegian children followed longitudinally, at the ages of 6 mo (n= 278), 12 mo (n= 249) and 24 mo (n= 231) by measuring haemoglobin (Hb), mean cell volume (MCV) and serum ferritin. At 6, 12 and 24 mo of age, 3, 10 and 12%, respectively, had iron deficiency anaemia (IDA) defined as Hb <110 g/l in combination with ferritin <15 μg/l. With more restrictive criteria for defining IDA 10 μg/l) increased from 2 to 3% at 6 mo, from 5 to 7% at 12 mo and from 9 to 13% at 24 mo.

Conclusion: Mild iron deficiency anaemia exists among otherwise healthy Norwegian infants and toddlers. The prevention and early treatment of iron deficiency should be a priority for the child health services.
Screening of coeliac disease in north Italian children with type 1 diabetes: limited usefulness of HLA‐DQ typing
Authors: Contreas G , Valletta E , Ulmi D , Cantoni S , Pinelli L
Published: August 2010

Aim: To determine the contribution of HLA‐DQA1* and HLA‐DQB1* genes to the risk of coeliac disease (CD) in a cohort of children with type 1 diabetes mellitus (T1DM) from northern Italy. Methods: Three hundred and fifty‐seven children with T1DM, attending the Childhood Diabetes Unit of the University of Verona, have been regularly tested for serum IgA endomysial antibodies (EMA). All patients with positive EMA underwent small bowel biopsy to confirm the diagnosis of CD. HLA typing was performed in subjects with T1DM and CD, and in a control group of 79 EMA‐negative patients with T1DM. Results: Of the 357 patients tested, 25 (7%) had CD. The frequency of HLA‐ DQA1*0501‐DQB1*0201 (T1DM + CD 68% vs T1DM 62%) and of DQA1*0301‐DQB1*0302 (T1DM + CD 40% vs T1DM 35%) haplotypes, between T1DM patients with and without CD, was statistically comparable. A trend towards a reduction of the risk of CD (p= 0.055, OR: 0.22, CI 0.05: 1.04) was observed in patients with T1DM (28% vs T1DM + CD 2%) who did not carry either the HLA‐DQA1*0501‐DQB1*0201 or the DQA1*0301‐DQB1*0302 haplotype.

Conclusion: A high prevalence of HLA‐DQA1* and ‐DQB1* susceptibility haplotypes for CD was observed both in EMA‐negative diabetics and in those with associated CD. The implementation of screening programmes of CD in a T1DM population, based on the identification of HLA susceptibility haplotypes, seems to be of limited usefulness. Serial serologic screening of diabetic patients remains the advisable strategy.
Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery
Authors: Zanardo V , Simbi AK , Franzoi M , Soldá G , Salvadori A , Trevisanuto D
Published: August 2010

Aim: To establish whether the timing of delivery between 37 + 0 and 41 + 6wk gestation influences neonatal respiratory outcome in elective caesarean delivery, following uncomplicated pregnancy, thus providing information that can be used to aid planning of elective delivery at term. Methods: All pregnant women who were delivered by elective caesarean delivery at term during a 3‐y period were identified from a perinatal database and compared retrospectively with pregnant women matched for week of gestation, who were vaginally delivered. Maternal characteristics, neonatal outcome, incidence of respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) were analysed. During this time, 1284 elective caesarean section deliveries occurred at or after 37 + 0 wk of gestation. Results: Neonatal respiratory morbidity risk (odds ratio, OR), including RDS and TTN, was significantly higher in the infant group delivered by elective caesarean delivery compared with vaginal delivery (OR 2.6; 95% CI: 1.35–5.9; p < 0.01). While TTN risk in caesarean delivery was not increased (OR 1.19; 95% CI: 0.58–2.4; p > 0.05), the RDS risk was significantly increased (OR 5.85; 95% CI: 2.27–32.4; p < 0.01). This RDS risk is greatly increased in weeks 37 + 0 to 38 + 6 (OR 12.9; 95% CI: 3.57–35.53; p < 0.01). After 39 + 0 wk, there was no significant difference in RDS risk.

Conclusions: Infants born by elective caesarean delivery at term are at increased risk for developing respiratory disorders compared with those born by vaginal delivery. A significant reduction in neonatal RDS would be obtained if elective caesarean delivery were performed after 39 + 0 gestational weeks of pregnancy.
Health‐related fitness in Swedish adolescents between 1987 and 2001
Authors: Ekblom Ö , Oddsson K , Ekblom B
Published: August 2010

Aim: To assess trends in neuro‐muscular and cardio‐respiratory fitness and morphological fitness in Swedish adolescents between 1987 and 2001. Methods: Comparison of data from two samples, one from 1987 (n= 479) and one from 2001 (n = 1470). Subjects underwent functional tests of muscular strength in the lower limbs, trunk and upper body, sub‐maximal ergometrics, and measurement of body mass and height. Results: Cardio‐respiratory fitness showed only small changes between 1987 and 2001 among boys, with no changes in girls. Neuro‐muscular fitness, as measured by three functional tests, was lower in 2001 compared to 1987. The most pronounced changes in these functional tests were found in the arm‐hang test, while changes in lower body and trunk strength tests were less. Our results indicate that the difference in the prevalence of overweight in adolescents between 1987 and 2001 is mainly due to a large change in the most unfit group. The fittest group showed only marginal changes.

Conclusion: We suggest that the differences in neuro‐muscular fitness are at least partly due to differences in the amount and nature of physical activity, and that this might lead to consequences for health later in life.
A descriptive survey of Swedish child health nurses' awareness of abuse and neglect. II. Characteristics of the children
Authors: Lagerberg D
Published: August 2010

Aim: To determine whether children considered by child health nurses to be at risk of abuse or neglect differed from the general population in gender, age and health status, and whether such child characteristics were related to nurses' perceptions of case seriousness, or to reporting to the child protection services (CPS). Methods: Questionnaires were sent to nurses in the preventive Child Health Services, 951 of whom identified a total of 6044 children aged 0 to 6 y as suspected of risk of maltreatment. Results: Boys and older children were over‐represented among the identified children, possibly because the attention of the nurses was attracted by salient symptoms in older boys. Children with health problems and boys exposed to disturbed parenting/neglect were perceived as more serious cases than other children. Children aged 4–6 y were more likely to be reported to the CPS than children under 3 y of age.

Conclusion: The findings raise the question whether possibly maltreated children who are very young, female or in good health run a particularly high risk of non‐detection, of being considered non‐serious cases and of not being reported to the CPS. The risk of going unnoticed may be higher for some children at risk of maltreatment than for others.
Helicobacter heilmannii gastroduodenal disease and clinical aspects in children with dyspeptic symptoms
Authors: S±kora J , Hejda V , Varvařovská J , Stožick± F , Siala K , Schwarz J
Published: August 2010

Aim: To evaluate the occurrence and clinical characteristics of Heliobacter heilmannii infection among children presenting with dyspeptic symptoms. Method: Prospective cohort study of 580 patients. Results: Of all examined dyspeptic children, 26.4% were infected with spiral‐shaped organisms, and 0.9% of patients were found to be infected with spiral H. heilmannii‐like organisms.

Conclusion: In children with dyspeptic symptoms, the possible presence of gastroduodenal disease due to H. heilmannii should be considered. Further studies are needed to clarify H. heilmannii‐related gastroduodenal pathology in the paediatric population.
Early protein intakes and adiposity: reloaded or downloaded?
Authors: Riva E , Verduci E , Giovannini M , Agostoni C
Published: August 2010

It has been hypothesized that feeding human milk through the first year of life may have a protective effect towards a later adiposity development, in contrast with formula feeding. The low protein content of human milk has been hypothesized as a plausible biological hypothesis. Regardless, it is often underscored that feeding human milk is associated with a higher rate of weight gain in the first two months of life.

Conclusion: In our opinion, it seems that the protective effect of human milk, if any, on adiposity development is far more complex, and tightly bound to the peculiarity of human milk composition and breastfeeding practice.
Increased QT dispersion in breath‐holding spells
Authors: Jr FJ DiMario
Published: August 2010

Breath‐holding spells (BHS) in children can be a frightening and clinically challenging paroxysmal, non‐epileptic childhood disorder. The pathophysiology has been found to incorporate central nervous system dysregulation in addition to an underlying genetic predisposition. Akalin and colleagues found group differences (BHS versus controls) in QT dispersion and QTc dispersion. These differences, however, may have been affected mainly by normal sinus arrhythmia from the predominant cyanotic BHS cohort.

Conclusion: The subtle differences measured in the current study between pallid and cyanotic breath‐holder groups, in terms of increased QTc dispersion in the pallid group, may represent an additional factor impacted upon by the resting state of underlying central autonomic dysregulation.
Monitoring of IgE‐mediated food allergy in childhood
Authors: Thong BY‐H , Hourihane JO'B
Published: August 2010

Background: The prevalence of IgE‐mediated food allergy (FA) in childhood varies from 6% to 8% in the first year of life compared to 1% to 2% in adults. In contrast to adults, FA in childhood, often part of the “allergic march”, resolves in more than 85% of children, especially those with hypersensitivity to cow's milk and egg. Aim: This paper explains the rationale for continuing care for childhood FA and describes how children should be monitored for resolution/persistence of FA. Methods: A clinical, multidisciplinary approach and management algorithm based on relevant, peer‐reviewed original research articles and reviews using the keywords anaphylaxis, atopic eczema, children, milk allergy, double‐blind placebo‐controlled food challenge, egg allergy, epinephrine, failure to thrive, food allergy, food challenge, food hypersensitivity, immunoglobulin E, nutrition, natural history, paediatrics, peanut allergy, prevalence, psychosocial factors, quality of life, radioallergosorbent test, and tolerance from years 1966 to 2003 in MEDLINE. Additional studies were identified from article reference lists. Results: A combination of outcome measures, a multidisciplinary approach involving a dietitian and allergy nurse specialist, and a management algorithm are useful tools in clinical management.

Conclusions: Prospective studies of non‐selected children, optimally from birth cohorts, are needed to evaluate the effects of such management programmes regarding FA in childhood.
A high neonatal serum eosinophil cationic protein level is a risk factor for atopic symptoms
Authors: Monti G , Peltran A , Coscia A , Bertino E , Ferrero L , Savant‐Levet P , Guala G , Altare F , Russo R , Fabris C
Published: August 2010

Aim: To show whether neonatal eosinophil counts (EC) and eosinophil cationic protein (ECP) can be used in assessing the risk of atopy, alone or in combination with family history of atopy (FHa). Patients and methods: A group of 63 newborns was included: 38 with FHa, 25 without FHa. A blood sample was collected on the 4th day of life for EC and ECP evaluation. Clinical follow‐up was conducted after 1, 3, 6, 12, 18, 24 and 36 mo. The χ2 test and the Student's t‐test were used to compare dichotomic and continuous variables, respectively. Variables shown to be significant by univariate analysis were evaluated with a multivariate regression model and the relative risks (RR) were estimated. Results: Twenty‐six newborns (41%) displayed atopic manifestations during the follow‐up. Twenty‐one (55%) of 38 newborns with FHa displayed atopic symptoms versus 5/25 (20%) without FHa (p 0.012). Neither EC nor serum ECP levels were significantly different between newborns with FHa and newborns without. ECP levels did not differ between newborns with single heredity and newborns with dual heredity. EC did not differ significantly between newborns who developed atopy and those who did not. Instead, serum ECP levels were significantly higher in newborns who developed atopy (mean 27.9 μU/1 vs 16.8 μU/1). Atopic manifestations appeared in 16 (62%) of 26 newborns with ECP ±18 μU/1 compared with 10 (27%) of 37 with ECP >18 μU/1 (p= 0.006). In the multivariate regression model, with ECP >18 μU/1 and no FHa as reference class, the class 1 (no FHa and ECP ±18 μU/1) has a low RR (1.4), class 2 (FHa and ECP >18 μU/1) an intermediate RR (2.7) and class 3 (FHa and ECP ±18 μU/1) a very high RR(16.3).

Conclusions: Neonatal serum ECP levels, in contrast with EC, were significantly higher in newborns who developed atopic manifestations during follow‐up. The risk of atopy was about twice as great when ECP was ±18 μU/1 (and four times as great in multivariate analysis). When serum ECP was combined with FHa, the RR for newborns with FHa and ECP ± 18 μU/1 was 16 times greater than for those without FHa and ECP ±18 μU/1. The identification of newborns at “extremely high atopic risk” (FHa and ECP ± 18 μU/L) may be expecially useful—in clinical practice—in newborns with only one atopic parent or sibling, for whom it is not universally agreed that dietary and environmental prevention measures should be applied.
Increased QT dispersion in breath‐holding spells
Authors: Akalin F , Turan S , Güran T , Ayabakan C , Yilmaz Y
Published: August 2010

Aim: Breath‐holding spells are common in infancy and early childhood, and patients are frequently referred to paediatric cardiology clinics for exclusion of heart disease. Recent data reveal subsequent development of epilepsy and neurocardiogenic syncope. Autonomic dysregulation and increased vagal stimulation leading to cardiac arrest and cerebral ischaemia is considered as the cause. Iron deficiency anaemia may be associated with these spells. We studied QT dispersion for the assessment of ventricular repolarization in these patients. Methods: The study group consisted of 19 girls and 24 boys between 3 and 108 mo of age (mean ± SD = 22.7 ± 17.7 mo); and the control group consisted of 13 girls and 12 boys between 3 and 57 mo of age (mean ± SD = 22.9 ± 15.1 mo). QT interval was measured; corrected QT interval (QTc), QT dispersion (QTd) and QTc dispersion (QTcd) were calculated from 12‐lead surface electrocardiograms of the patients and the control group. Results: There was no statistically significant difference in terms of QT and QTc intervals between patient and control groups, while QTd and QTcd values were significantly increased in patients with breath‐holding spells compared to the healthy children. QT dispersion was 59.5 ± 35.9 ms and 44.8 ± 11.9 ms, respectively, in patients and controls (p < 0.05). QTc dispersion was 102.1 ± 41.9ms and 79.6 ± 24.6ms, respectively (p < 0.01). The presence of iron deficiency did not effect the QT and QTc dispersion.

Conclusion: QT dispersion is increased in patients with breath‐holding spells, and this finding justifies further investigation for rhythm abnormalities and autonomic dysfunction in this patient group.
The role of matrix metalloproteinases ‐9 and ‐2 in development of neonatal chronic lung disease
Authors: Sweet DG , Curley AE , Chesshyre E , Pizzotti J , Wilbourn MS , Halliday HL , Warner JA
Published: August 2010

Aim: Matrix metalloproteinases (MMPs) ‐9 and ‐2 degrade type‐IV collagen, a major constituent of lung basement membrane, and may have a role in the pathogenesis of neonatal chronic lung disease (CLD). We determined factors influencing MMP levels in neonatal bronchoalveolar lavage (BAL) fluid to establish whether an imbalance between MMP and its inhibitor could be implicated in CLD. Methods: We measured MMP‐9 and ‐2 and tissue inhibitor of metalloproteinase‐1 (TIMP‐1) levels in 316 BAL fluid samples from 121 babies of gestational ages 23 to 42 wk over the first 14 d of life to determine effects of gestation and postnatal age. Median MMP‐9, ‐2, TIMP‐1 and MMP‐9/TIMP‐1 ratio in BAL were further studied in a subgroup of 85 babies >33 wk gestation to determine their ability to predict CLD and to establish effects of antenatal corticosteroid therapy (ANCS). Results: MMP‐9, ‐2 and TIMP levels did not vary with postnatal age over the first week. Median MMP‐9 levels and MMP‐9/TIMP‐1 ratio increased with decreasing gestation in preterm babies. The MMP‐9/TIMP‐1 ratio was higher in babies who developed CLD, implying a proteinase/antiproteinase imbalance, but this association disappeared when controlled for gestational age. ANCS had no effect on BAL fluid MMP or TIMP levels.

Conclusion: MMPs may have a role in the development of lung injury and fibrosis, but estimating their levels in the first week of life does not help with prediction of CLD.
Intestinal microflora in breastfed colicky and non‐colicky infants
Authors: Savino F , Cresi F , Pautasso S , Palumeri E , Tullio V , Roana J , Silvestro L , Oggero R
Published: August 2010

Background: Infantile colics are a common problem in the first months of life. During this period, a process of intestinal colonization rapidly occurs. A difference in the gut microflora could play an important role in the pathogenesis of colics, changing the metabolism of carbohydrates and fatty acids. Actually, in the literature, only few data have been collected about this topic. In this study, we evaluated intestinal microflora in breastfed colicky and non‐colicky infants. Methods: Seventy‐one breastfed infants, aged 3.2 ± 0.6 wk, free from episodes of gastroenteritis and without previous assumption of antibiotic and probiotic drugs, were enrolled in the study. They were divided into two groups: colicky (42 cases) and non‐colicky (29 cases), according to Wessel's criteria. Stool samples were collected, diluted and cultured on several selective media to detect lactobacilli, clostridia, Gram‐negative anaerobes and Enterobacteriaceae. Statistical analysis was performed using Student's t‐test, χ2 test and a non‐parametric test (Mann‐Whitney U‐test). Results: Differences in gut microflora were found among colicky and non‐colicky infants: colicky infants were less frequently colonized by Lactobacillus spp., and more frequently by anaerobic Gram‐negative bacteria.

Conclusion: Our study indicates that colicky infants have different patterns of gut microflora. Further studies are required to understand whether gut microflora is the primary cause of colics or its consequence.
Video reveals self‐stimulation in infancy
Authors: Casteels K , Wouters C , Van Geet C , Devlieger H
Published: August 2010

The medical literature on early childhood masturbation is sparse. Only 12 patients who presented with infantile self‐stimulation under the age of 1 y are described. During the last 2 y, five girls under 1 y of age presented at our department with self‐stimulating behaviour. The diagnosis of this behaviour was difficult, but could be made by watching a video of the attacks. Infantile self‐stimulation is often misdiagnosed and unnecessary investigations and useless treatments are often prescribed. Video recording can be of great help to put forward the correct diagnosis. Masturbation is not so uncommon and treatment consists mostly in reassuring the parents. It can, however, be associated with behavioural problems. Few data are available on the clinical outcome of childhood masturbation, but most children seem to develop normally.

Conclusion: Infantile self‐stimulation should always be considered in the differential diagnosis of “strange episodes or attacks”.
Linear IgA bullous dermatosis of neonatal onset: case report and review of the literature
Authors: Kishida Y , Kameyama J , Nei M , Hashimoto T , Baba K
Published: August 2010

Several small blisters were noticed on the forehead and the trunk of a newborn boy on day 1. The blisters gradually enlarged and spread over the whole body including the oral mucosa. A skin biopsy was performed twice and subepidermal bullae with polymorphonuclear and mononuclear cell infiltration were demonstrated. Direct immunofluorescence showed linear IgA, IgG and C3 depositions along the basement membrane zone and this finding led to a diagnosis of linear IgA bullous dermatosis. So far, internationally, only one case has ever been reported on the disease at neonatal onset. The skin lesions spontaneously regressed and the mucosal lesions were controlled with diaminodiphenylsulfone.

Conclusion: In neonates with prolonged blistering, autoimmune disease such as linear IgA bullous dermatosis should be considered within the differential diagnosis and an immunofluorescence study must be performed.
New findings in partial trisomy 16q: clinical report
Authors: Sousa B , Rocha G , Doria S , Alves JR , Guedes B , Guimarães H
Published: August 2010

Partial trisomy 16q is a rare disorder associated with significant dysmorphism, psychomotor retardation and limited postnatal survival. A female infant with a partial trisomy 16q from a de novo translocation 11;16 is described. Clinical findings were consistent with previous reports, with the exceptions of megalocornea, partial callosal agenesis and mild bilateral occipital lobe hypoplasia.

Conclusion: Based on this clinical report, megalocornea, partial callosal agenesis and mild bilateral occipital lobe hypoplasia should perhaps be included in the list of anomalies associated with partial trisomy 16q.
Haemopoietic growth factors for neonates: assessing risks and benefits
Authors: Carr R , Modi N
Published: August 2010

This review summarises the rationale, clinical trial evidence for benefit and potential toxicities of Erythropoietin, Thrombopoietin, Granulocyte Colony Stimulating Factor and Granulocyte‐Macrophage Colony Stimulating Factor. Erythropoietin has failed to have a clinical impact on red cell transfusion requirement in very low birth weight infants; it is uncertain whether Thrombopoietin will find a significant clinical role in neonatal thrombocytopenia and there is, as yet, insufficient evidence for the routine use of Granulocyte‐ or Granulocyte‐Macrophage Colony Stimulating Factor to prevent or treat bacterial infection. A number of theoretical risks of haemopoietic growth factor use in neonates have been suggested, but no toxicities have been observed during their clinical use. Exploring the potential for benefit in selected groups of infants should be encouraged.
Recent advances in diagnosis and management of pulmonary hypertension in chronic lung disease
Authors: Subhedar NV
Published: August 2010

Pulmonary hypertension with elevated pulmonary vascular resistance is a common cardiovascular complication associated with increased morbidity and mortality in preterm infants with chronic lung disease. Injury to the developing pulmonary circulation results in structural and functional abnormalities of the pulmonary vasculature. Animal studies have demonstrated that disruption of angiogenesis may contribute to the failure of normal alveolarisation in chronic lung disease. Levels of vascular endothelial growth factor in bronchoalveolar lavage fluid are lower in infants with chronic lung disease compared to preterm controls. Supplemental oxygen is commonly used to prevent and treat pulmonary hypertension, although optimal arterial oxygen saturation levels remain uncertain. Other vasodilators such as inhaled nitric oxide appear promising, but as yet have not been evaluated in the form of randomised controlled trials. Further studies are required to investigate the long‐term effectiveness of pulmonary vasodilator therapy.
The genetic basis for measles vaccine failure
Authors: Jacobson RM , Poland GA
Published: August 2010

The US measles epidemics of 1989–1991 included a series of outbreaks resulting from vaccine failure. A series of studies was launched aimed at elucidating the mechanisms of this vaccine failure. A meta‐analysis of the literature examining epidemics in vaccinated populations was conducted, which showed that the secondary vaccine failure rate (development of the disease despite an initial or primary vaccine success) is no more than 0.2%. The overwhelming proportion of measles vaccine failure was due to primary vaccine failure (failure to ever generate antibody from antigenic stimulation). This comparison of two geographically distinct communities revealed that 10% of children previously vaccinated against measles lacked antibody on follow‐up and that these vaccine failures clustered in families. A study of monozygotic and dizygotic twins revealed a high degree of heritability of measles vaccine antibody level. Subsequent studies found associations with both class I and class II alleles in these population‐based studies. In the future, detection of the specific peptides that interact with human leukocyte antigen (HLA) molecules may serve as the basis for improved vaccines and address vaccine failure that results from cold‐chain problems, immaturity of the immune system, malnutrition and maternal immunity.
A mitochondrial ATPase 6 mutation is associated with Leigh syndrome in a family and affects proton flow and adenosine triphosphate output when modeled in Escherichia coli
Authors: Carrozzo R , Rizza T , Lucioli S , Pierini R , Bertini E , Santorelli FM
Published: August 2010

A multidisciplinary strategy was used to identify the molecular defect in a family with Leigh syndrome (LS). The propositus presented severe developmental delay, an ataxic‐spastic gait and seizures. She died at 3.5 y of age from cardiorespiratory arrest. Postmortem examination disclosed pathological features typical of LS. A 12‐y‐old sister is affected with the same disease. Respiratory chain enzyme complex activities in skeletal muscle biopsy were normal. Adenosine triphosphate (ATP) synthesis during oxidative phosphorylation in skin fibroblasts mitochondria showed a severely hampered ATP production. Mitochondrial DNA sequencing revealed a new mutation in the ATPase 6 gene (T9176G). Site‐directed mutagenesis in Escherichia coli strains was used to measure H+ pumping and ATP synthesis. Results were comparable to findings obtained in human cells. These data corroborate the use of E. coli strains as a feasible “animal” model for functional studies in pathogenic mutations of the ATPase 6 gene.
Wilms' tumor and neuroblastoma
Authors: Morgenstern BZ , Krivoshik AP , Rodriguez V , Anderson PM
Published: August 2010

Significant differences exist between the European and North American treatment protocols for Wilms' tumor and neuroblastoma. There are variations in biopsy technique, timing and extent of initial surgery, chemotherapy protocols and dosage routines, as well as the type of salvage therapy. With the consolidation of the two major North American study groups into a single entity (Children's Oncology Group), the European and North American study groups represent the only remaining large‐scale venues for treatment comparison. It is important to study and understand the variation in treatment protocols in order to maintain an open forum of scientific investigation that will lead to improving the care and outcome of children with cancer. It is anticipated that the unification of the North American groups will lead to greater interest and scientific cooperation with the European study group. This paper will serve as a forum for such a discussion at a local level.
Early hypocarbia of preterm infants: Its relationship to periventricular leukomalacia and cerebral palsy, and its perinatal risk factors
Authors: Murase M. , Ishida A.
Published: August 2010

Aim: To clarify clinical interactions between early hypocarbia, periventricular leukomalacia (PVL) and cerebral palsy of preterm infants. Methods: Serial measurements of PaCO2 using arterial blood samples at 3, 6, 12, 24 and 48 h of life were performed for 115 very‐low‐birthweight infants admitted between 1995 and 1999. Severe early hypocarbia, defined when at least two of five PaCO2 values showed 3.3 kPa or less, was observed in eight infants (hypocarbia group). Preterm PVL was diagnosed by serial ultrasonographic examinations and cranial magnetic resonance imaging, and subsequently classified into early‐onset PVL diagnosed within 14 d, or late‐onset PVL after 14 d. Perinatal risk factors for early hypocarbia were investigated from the mothers' records and interviews with obstetricians. Results: The average birthweight in the hypocarbia group was significantly smaller than that in the control group (p<0.01). The occurrence of PVL in the hypocarbia group was not different from that in the control group. Early hypocarbia was significantly related to late‐onset PVL (p<0.001), but not related to early‐onset PVL. The incidence of cerebral palsy in the hypocarbia group was significantly higher than that in the control group (p<0.001). Multivariate analysis showed that both low birthweight and number of maternal previous abortions were predictive for early hypocarbia.

Conclusion: Early hypocarbia of preterm infants in our hospital was significantly associated with both cerebral palsy and late‐onset PVL, but not with early‐onset PVL. The background of the three clinical events, early hypocarbia, PVL, and cerebral palsy, may not be identical in human newborns.