bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of sweat electrolytes to apparent life‐threatening events (ALTE): a case control study
Authors: Tirosh E , Haddad F , Lanir A , Tal Y , Cohen A
Published: January 2008

Twenty infants aged 25 days to 6 months who were consecutively investigated for apparent life‐threatening events (ALTE) with negative results and 20 matched normal controls underwent an iontophoresis sweat test. A statistically significant elevated sweat potassium level (22.1 × 8.9 versus 12.4 × 6.5mol/l) was noted in the ALTE patients compared with the control group (p < 0.001). No difference was found, however, between sweat sodium and chloride levels in the two groups. Na/K ratio in sweat was significantly different between the groups (p < 0.001). A between‐groups discriminant analysis, using Na/K ratio as a discriminant variable, resulted in 80% accuracy in group assignment. A significant increase in sweat potassium concentration at night compared with day time was evident in ALTE patients. Elevated sweat potassium levels specifically characterized infants who experienced ALTE and may possibly indicate an underlying mechanism involving enhanced sympathetic activity.
Treatment of EBV‐induced lymphoproliferative disorder with epipodophyllotoxin VP16–213
Authors: Migliorati R , Castaldo A , Russo S , Porta F , Fiorillo A , Guida S , Poggi V , Guarino A
Published: January 2008

A case of haemophagocytic lymphohistiocytosis consistent with X‐linked lymphoproliferative disorder is described. Remission was observed after administration of VP‐213, a cytotoxic drug generally used to treat histiocytosis. The child is currently in good clinical health.
The role of aluminium for adverse reactions and immunogenicity of diphtheria‐tetanus booster vaccine
Authors: Mark Anders , Granström Marta
Published: January 2008

In a randomized, double‐blind clinical trial, 235 schoolchildren aged 10 years received either a regular, aluminium‐adsorbed diphtheria‐tetanus vaccine or the same vaccine in fluid form, in order to investigate if local side effects could be diminished by exclusion of aluminium. System reactions were rare and local reactions frequent in both groups but larger local reactions were even more pronounced in the non‐adsorbed vaccine group. Antibody responses to both vaccines were excellent and even slightly higher to the non‐adsorbed diphtheria‐tetanus vaccine (p= 0.0135 and 0.0014 for anti‐diphtheria and anti‐tetanus, respectively). This study has shown that fluid diphtheria‐tetanus vaccine does not solve the problem of extensive local side effects induced by the diphtheria‐tetanus school booster. Alternative strategies, such as changes in vaccine composition. dosage and spacing, will have to be considered.
Cow's milk versus soy‐based formula in mild and moderate diarrhea: a randomized, controlled trial
Authors: Allen Upton D , McLeod Kathryn , EL Wang Elaine
Published: January 2008

We determined the efficacy of a soy‐based formula compared with a cow's milk formula in infant re‐feeding after acute diarrhea in a randomized controlled double‐blind clinical trial. Infants 2–12 months of age with diarrhea of less than one week's duration and mild or moderate dehydration admitted to a pediatric hospital or in the practice of a participating primary care pediatrician were investigated. Seventy‐six patients were enrolled and 73 completed the study; 39 infants received a soy‐based formula (Isomil) and 34 received a cow's milk formula (SMA). Hospitalized patients were rehydrated with an oral glucose‐electrolyte solution or an iv dextrose‐sodium solution. Outpatients received oral glucose‐electrolyte solution. In all patients, the study formula was commenced ad libitum during the first 24 h as determined by the attending pediatrician. The primary outcome measure was duration of diarrhea, defined as time to first normal stool, when subsequent stools were normal for a 24‐h period. In addition, a predetermined secondary outcome was proportion of treatment failures, defined as the need to reinstitute clear fluids because of emesis, refusal to accept study formula, need for iv fluids due to negative fluid balance or diarrhea persisting beyond 7 days after enrollment. Total duration of diarrhea was significantly longer (p= 0.03) in those receiving cow's milk (mean±SD 6.6 ± 4.2 days) than in those receiving soy‐based formula (4.5 ± 3.6 days). Volume of formula intake and weight gain at 14 days were not different in the two groups. There were 18 treatment failures in the cow's milk formula recipients and 13 failures in the soy formula recipients (p= 0.08). Soy‐based formula significantly shortened the duaration of acute diarrhea in well nourished infants compared with cow's milk formula.
Dietary modifications versus dicyclomine hydrochloride in the treatment of severe infantile colics
Authors: Oggero R , Garbo G , Savino F , Mostert M
Published: January 2008

This study examined 120 infants, aged 3–12 weeks, with severe colics and compared the results of a specific hypoallergenic diet (group A) with those of pharmacological treatment (group B). Non‐breastfed group A infants received soy milk and if unresponsive, hydrolyzed milk formulas; mothers of breast‐fed infants received a diet without cow's milk, eggs or fish. Breast‐fed and non‐breast‐fed group B infants received dicyclomine hydrochloride 3 mg/kg/day. Results, based on quantitative measurements of crying. indicated that in breast‐fed infants there was no significant improvement between group A (62.5%) and group B (66.6%) infants. Among formula‐fed infants, comparison of positive results using soy milk (65.9%) with positive results using dicyclomine (53.3%) was not significant; positive results using soy milk and hydrolyzed milk formulas in non‐responders to soy milk, provided an improvement in 95.4% of cases. Pharmacological treatment provided an improvement in 53.3%) of cases. The diffcrence was significant (p<0.01).
Faecal short chain fatty acids in breast‐fed and formula‐fed babies
Authors: Edwards Christine A , Parrett Alison M , Balmer Susan E , Wharton Brian A
Published: January 2008

Edwards CA, Parrett AM, Balmer SE, Wharton BA. Faecal short chain fatty acids in breast‐fed and formula‐fed babies. Acta Pædiatr 1994;83:459–62. Stockholm. ISSN 0803–5253

The intestinal flora of breast‐fed infants differs from that of formula‐fed infants. It is thought that this difference in flora may be one important reason why breast‐fed babies suffer less from gastrointestinal disease. Differences in intestinal flora are reflected in the profile of faecal short chain fatty acids (SCFA). Very little is known about faecal concentrations of SCFA in babies fed breast milk or infant formula. In this study, faecal SCFA were measured in babies at two and four weeks of age who had been either exclusively breast fed or bottle fed from birth. There was no significant difference in total faecal SCFA concentrations between breast‐fed and formula‐fed babies when lactate was included. The formula‐fed group, however, had less lactic acid and higher concentrations of propionic and n‐buytric acids than breast‐fed babies. Very few babies had significant levels of n‐butyric acid, although this SCFA is believed to be important for the health of the colonic mucosa of adults.
Lipoprotein changes in small‐for‐gestational‐age infants fed nucleotide‐supplemented milk formula
Authors: Morillas J , Moltó L , Robles R , Gil A , Sanchez‐Pozo A
Published: January 2008

Morillas J, Moltó L, Robles R, Gil A, Sánchez‐Pozo A. Lipoprotein changes in small‐for‐gestational‐age infants fed nucleotide‐supplemented milk formula. Acta Prediatr 1994;83:481–5. Stockholm. ISSN 0803–5253

We determined the effect of supplementing milk formula with nucleotides on plasma lipoproteins in small‐for‐gestational‐age infants: 21 infants were fed a nucleotide‐supplemented formula and 20 infants were fed the same nucleotide‐free formula. On days 0, 3 and 7 after birth, major plasma lipoprotein fractions were analyzed for apolipoprotein and lipid composition. Compared with the control group, the group receiving nucleotides had increased total apoprotein concentrations in all lipoproteins as well as increased apo A‐I in high‐density lipoproteins and very low‐density lipoproteins, and apo B‐100 in very low‐density lipoproteins and low‐density lipoproteins. Very low‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol and very low‐density lipoprotein triglycerides increased in parallel to the changes in apoproteins. The cholesterol ester to unesterified cholesterol ratio was increased in low‐density lipoproteins and, particularly, in high‐density lipoproteins. These data support the hypothesis that lipoprotein metabolism in small‐for‐gestational‐age infants is affected by dietary nucleotide supplementation, enhancing lipoprotein synthesis or secretion. Cholesterol esterification capacity paralleled the apo A‐I increase, in agreement with the co‐factor role of apo A‐I on lecithin: cholesterol acyltransferase.
Reversible changes in cerebral activity associated with acidosis in preterm neonates
Authors: Eaton Deborah G Murdoch , Wertheim David , Oozeer Rowena , Dubowitz Lilly MS , Dubowitz Victor
Published: January 2008

Murdoch Eaton DG, Wertheim D, Oozeer R, Dubowitz LMS, Dubowitz V. Reversible changes in cerebral activity associated with acidosis in preterm neonates. Acta Paediatr 1994;83:486–92. Stockholm. ISSN 0803–5253

Computerized online EEG monitoring in ventilated preterm infants less than 32 weeks' gestation enabled evaluation of the effect of acidosis on cerebral function. All episodes of acidosis were found to be associated with changes in the levels of cerebral activity. In 21 of the 32 episodes, EEG activity returned to pre‐acidosis levels after therapeutic intervention. The duration of EEG abnormality was related to the severity of acidosis. However, the time to recovery of the EEG after therapeutic procedures was not related to duration of the EEG change.
Accuracy of central venous pressure measurements in the inferior vena cava in the ventilated child
Authors: Murdoch IA , Rosenthal E , Huggon IC , Coutinho W , Qureshi SA
Published: January 2008

Murdoch IA, Rosenthal E, Huggon IC, Coutinho W, Qureshi SA. Accuracy of central venous pressure measurements in the inferior vena cava in the ventilated child. Acta Pædiatr 1994;83:512–14. Stockholm. ISSN 0803–5253

We compared central venous pressure measurements from three sites, superior vena cava, inferior vena cava and right atrium, in 12 children undergoing cardiac catheterization whilst on assisted ventilation. There was no significant difference between the mean pressures in the superior vena cava and the inferior vena cava. Furthermore, there was also no difference between the mean pressures in the inferior vena cava and the right atrium. Because of the greater safety of the placement of pressure monitoring lines in the inferior vena cava via the femoral vein, this approach should be the preferred route for central venous pressure monitoring in children.
Effects of salbutamol inhalations on transcutaneous blood gases in children during the acute asthmatic attack: from acute deterioration to recovery
Authors: Holmgren D , Sixt R
Published: January 2008

Holmgren D, Sixt R. Effects of salbutamol inhalations on transcutaneous blood gases in children during the acute asthmatic attack: from acute deterioration to recovery. Acta Pædiatr 1994;83:515–19. Stockholm. ISSN 0803–5253

Nine children, 7–16 years of age, were studicd repeatedly during an acute asthmatic attack, from acute deterioration to recovery. The transcutaneous blood gases, forced expiratory volume in l s (FEV1) and maximum expiratory flow when 25% of vital capacity remained to be expelled (MEF25) were monitored before and after salbutamol inhalation. The flow‐volume variables were markedly impaired in the acute phase but improved gradually by the time of recovery. The transcutaneous PO2 (tcPO2) decreased in the acute and early recovery phase but improved by the late recovery phase. In the acute phase, the salbutamol inhalations increased the FEV1, indicating an improvement in central airway function, but also reduced the MEF25 and tcPO2 in some of the children. The changes in tcPO2 after the inhalations correlated with the changes in MEF25 (p< 0.001), thereby indicating a common denominator, probably the condition of the peripheral airways. In the recovery phase, the FEV1, MEF25 and tcPO2 improved after the inhalations (p < 0.05). In conclusion, transcutaneous PO2 can be used to evaluate the effects of treatment in children with acute asthmatic symptoms and may add information about peripheral airway function which may prove particularly valuable in small children where few methods are available for such measurements.
Effect of hydrochlorothiazide and indomethacin treatment on renal function in nephrogenic diabetes insipidus
Authors: Jakobsson B , Berg U
Published: January 2008

Jakobsson B, Berg U. Effect of hydrochlorothiazide and indomethacin treatment on renal function in nephrogenic diabetes insipidus. Acta Pædiatr 1994;83:522–5. Stockholm. ISSN 0803–5253

The purpose of this study was to investigate the effects of treatment with hydrochlorothiazide and hydrochlorothiazide and indomethacin combined on renal function in four boys, two with nephrogenic diabetes insipidus and two with partial nephrogenic diabetes insipidus using the clearances of inulin and para‐aminohippuric acid under water diuresis and lithium clearance. Hydrochlorothiazide reduced urine flow and lithium clearance. These effects were further potentiated by addition of indomethacin. No consistent effects on renal plasma flow or glomerular filtration rate were found. It is concluded that treatment with hydrochlorothiazide alone and hydrochlorothiazide and indomethacin combined reduces urine flow in nephrogenic diabetes insipidus by increasing proximal tubular reabsorption of sodium.
Steroid response pattern in Indian children with nephrotic syndrome
Authors: Gulati Sanjeev , Kher Vijay , Sharma RK , Gupta Amit
Published: January 2008

Gulati S, Kher V, Sharma RK, Gupta A. Steroid response pattern in Indian children with nephrotic syndrome. Acta Pædiatr 1994;83:530–3. Stockholm. ISSN 08033–5253

The steroid response pattern to standard prednisolone therapy is of immense diagnostic, therapeutic and prognostic value for the treating physician in managing children with nephrotic syndrome. None of the studies from our country has analysed the clinical, biochemical and histopathological profile in different steroid response categories. To address this problem we conducted a study comprising 127 children with nephrotic syndrome referred to our Institute. They were treated with oral prednisolone according to the APN protocol. Based on the subsequent response these children were classified into different steroid response categories on follow‐up. Of the 116 children with follow‐up of more than six months, infrequent relapsers constituted the majority (37.9%). The frequency of other steroid response categories was as follows: frequent relapsers (21.6%), steroid‐dependent (18.1%), initial non‐responders (17.3%) and subsequent non‐responders (5.1%). The factors predicting a poor response to standard prednisolone therapy in our study were age of onset more than eight years, male sex, hypertension, microscopic haematuria and presence of non‐minimal change nephrotic syndrome lesions on histopathology
Pattern and antibiotic susceptibility of bacteria in pyogenic meningitis in a children's emergency room population in Maiduguri, Nigeria, 1988–1992
Authors: Akpede George O , Adeyemi Olumuyiwa , Abba Aminu A , Sykes Roger M
Published: January 2008

From January 1988 to November 1992, 107 (3.5%) of 3074 postneonatal children admitted to the Children's Emergency Room, University of Maiduguri Tcaching Hospital, Nigeria. had sporadic pyogenic meningitis; 66 (61.7%) were aged ≤12 months. Streptococcus pneunioniue. Neisseria meningitidis and Huemophilus influenae together were responsiblc for 77.3% (58) of 75 culture‐proven cases, 13.4% (10) had Enterobactcriaceae, 5.3%) (4) had Stuphylococcus aureus and 4% (3) untyped α‐haemolytic streptococci. Fifty percent of 62 bacteria were resistant to ampicillin, 47.2% of 36 to penicillin and 10.7% of 56 to chloramphenicol; none of 21 bacteria was simultaneously resistant to all three antibiotics. Up until 1992. we havc encountered treatment failure with a regimen containing chloramphenicol in only 2 of 53 patients; the 2 patients had coliform meningitis. Nun‐meningococcal bacteria are an important cause of sporadic pyogenic meningitis in sub‐Saharan Nigeria and chloramphenicol is the most appropriate initial drug of choice at the present time for the management of sporadic meningitis.
Non‐genetic risk determinants for type 1 (insulin‐dependent) diabetes mellitus in childhood
Authors: Soltész Gyula , Jeges Sara , Dahlquist Gisela ,   The Hungarian Childhood Diabetes Epidemiology Study Group
Published: January 2008

Using the prospective Hungarian childhood diabetes register, a nationwide case‐control study was carried out to investigate the possible role of various non‐genetic factors as risk determinants for type 1 diabetes in childhood. A questionnaire (covering family characteristics, social status, fetal and perinatal events, breast‐feeding habits, infectious diseases and stressful life events) was sent by mail to all incident diabetic children in 1990 (n= 163) and to two referent children (for each diabetic chdd), matched for age, sex and county. Diabetic children had a tendency to have mothers > 35 years of age (odds ratio (OR) = 3.52; 95% confidence intervals (CI) 0.74–16.79), a lower proportion of their mothers had higher education (OR = 1.69; 95% CI 0.95–3.0) and these children tended to move home more frequently (OR = 1.99; 95% CI 0.97–4.1). Although the duration of exclusive breast feeding was similar in both groups, the proportion of diabetic children who received no breast milk tended to be higher (OR= 1.76; 95% CI 0.91–3.4). A higher proportion of diabetic children reported non‐specific infections (OR = 2.94; 95% CI 1.19–7.21) and the number of stressful life events was higher in diabetic children aged 10–14 years (OR = 3.9; 95% CI 1.14–13.27). As the risk determinants for childhood insulin‐dependent diabetes mellitus identified in our low‐risk population appear to be similar to those detected in the genetically different, high‐risk Swedish population, our study strongly supports an etiological role for these non‐genetic risk factors in IDDM.
Circulatory responses in children with unexplained syncope evaluated by continuous non‐invasive finger blood pressure monitoring
Authors: Tanaka Hidetaka , Thulesius Olav , Yamaguchi Hitoshi , Mino Makoto
Published: January 2008

Cardiovascular responses on active standing in children with unexplained syncope were investigated with continuous non‐invasive finger artery pressure monitoring (Finapres). We examined 34 symptomatic patients (13 boys and 21 girls), aged 8–16 years, and 24 age‐matched controls. Finger blood pressure and heart rate were monitored continuously for 5 min in the supine position and for 10 min while standing. Ten of 34 patients developed fainting symptoms with hypotension during upright posture (fainters). In the initial standing phase (0–30 s), two prominent abnormal blood pressure responses were found in patients: a marked decrease 45 f 18/23 ± 8 mmHg and a prolonged recovery time (16.5 ± 2.9 versus 27.7 ± 13.6 s), which appeared to be based on impaired vasoconstriction. Either or both abnormalities were observed in 21 (62%) of the 34 patients and in 2 (8%) of the controls. In addition, fainters also had a more marked increase in heart rate during standing compared with non‐fainters. Our findings suggested that more than half of children with syncope had abnormal cardiovascular reflexes in the initial phase which appeared to be associated with vasodepressor syncope. The active standing test with a continuous beat‐to‐beat blood pressure recording has a high sensitivity in detecting abnormalities of autonomic function in patients with unexplained syncope.
Nocturnal enuresis: sleep disturbance and behavioural patterns
Authors: Wille S
Published: January 2008

Sleep pattern and behaviour was studied in 88 children with nocturnal enuresis and compared with 340 non‐enuretic children. There were no differences in common psychosomatic complaints. Enuresis was almost three times more common in the families of the enuretic children than in the families of their non‐enuretic peers. The enuretics were considered deep sleepers by their parents. A wake‐up test showed that they were more difficult to arouse at night compared with controls (p < 0.001). These results demonstrate that enuresis has a strong genetic link and enuretics are characterized as deep sleepers but do not display different day‐time behavioural patterns compared with their non‐enuretic peers.
On the dynamics of the growth process
Authors: Karlberg J , Low L , Yeung CY
Published: January 2008

Recent publications have provided evidence that the short‐term growth process may be regarded as pulsatile rather than constant over time. The possible influence of changes in soft tissue thickness is one reason why it is not possible to draw any final conclusion about the existence or not of such a pulsatile short‐term growth pattern. An answer can probably not be reached until a method has been developed that measures longitudinal bone growth without any soft tissue involvement, especially since such a method has recently been used in the rabbit showing that the day‐to‐day growth rate was linear or continuous.
Neurofibromatosis associated with central alveolar hypoventilation syndrome during sleep
Authors: Sforza E , Colamaria V , Lugaresi E
Published: January 2008

We describe polygraphic respiratory alterations during sleep in a child with neurofibromatosis. The patient, a four‐year‐old boy, had a medical history of neurofibromatosis and recurrent acute respiratory failure responsive to mechanical ventilation. All‐night polysomnography showed severe nocturnal hypoventilation with marked hypercapnia (TcPaCO2 70 mmHg) and hypoxemia (SaO2 less than 40%). Nocturnal hypoxemia and hypercapnia and depressed response to the hyperoxic hypercapnic test confirmed the diagnosis of central hypoventilation syndrome. Cerebral magnetic resonance imaging disclosed lucent areas in the globus pallidus, mesencephalus and left upper pons. Therapy with nocturnal nasal positive bilevel ventilation reversed nocturnal hypoxemia and hypercapnia. This study suggests that patients with neurofibromatosis should be investigated for concomitant severe hypoventilation, particularly when clinical symptoms suggest brain stem lesions.
Travel and changes in routine do not increase the risk of sudden infant death syndrome
Authors: Mitchell EA , Nelson KP , Thompson JMD , Stewart AW , Taylor BJ , Ford RPK , Scragg R , Becroft DMO , Allen EA , Hassall IB , Roberts A
Published: January 2008

We investigated the relationship between travel and changes in routine and the sudden infant death syndrome (SIDS) among 485 SIDS cases compared with 1800 randomly selected control infants. There was no increased risk of SIDS with travel. Special events, such as christenings, were not associated with an increased risk of SIDS. However, visits to and by friends or relatives were associated with a significantly reduced risk of SIDS after controlling for potential confounders (odds ratios = 0.70; 95% confidence interval = 0.52, 0.96). These findings may indicate less social support in SIDS cases.
Hydrolyzed lactalbumin‐based oral rehydration solution for acute diarrhoea in infants
Authors: Sack R B , Castrellon J , Sera E Della , Goepp J , Burns B , Croll J , Tseng P , Reid R , Carrizo H , Santosham M
Published: January 2008

The addition of different organic substrates to standard glucose oral rehydration solution (G‐ORS) has been shown to improve the intestinal absorption of sodium and water, and thereby decrease stool losses. Therefore, we evaluated, in infants with acute diarrhoea, the safety and efficacy of three oral rehydration solutions (ORS) which had the same concentrations of electrolytes (with sodium 60 mmol/l) but different substrates of proteins and carbohydrates. One solution (LAD‐ORS) contained hydrolyzed lactalbumin (LAD) with maltodextrin and sucrose, a second (MS‐ORS) was identical but without LAD and a third (G‐ORS) was standard glucose ORS. The three solutions were compared in a double‐blind, randomized trial in 74 hospitalized well‐nourished children in Panama and the United States. All three oral rehydration solutions were equally efficacious and safe in these children, 54% of whom were infected with rotavirus. There was no suggestion that hydrolyzed lactalbumin or maltodextrin provided any advantage over glucose‐ORS in terms of stool output or in duration of diarrhoea. We conclude that all three solutions are efficacious in the therapy of acute diarrhoea in infants.
Acute rheumatic fever in children in the Ankara area in 1990–1992 and comparison with a previous study in 1980–1989
Authors: Karademir S , Demirgeken F , Atalay S , Demircin G , Sipahi T , Teziç T
Published: January 2008

Two hundred and twenty‐eight patients with acute rheumatic fever (ARF), who were admitted to Dr Sami Ulus Children's Hospital between January 1990 and November 1992, were evaluated. Compared with the 1980s, an increase in the frequency of the disease was observed. The majority of patients (56.5%) were between 9 and 12 years old and 36.8% were admitted in winter. One hundred patients had arthritis only, 59 carditis and 40 chorea; 5 had carditis and chorea and 24 had arthritis and carditis. Nineteen percent of patients had a history of a previous attack. Seven of 84 patients with carditis had congestive heart failure and 2 had pericarditis. Cardiomegaly was present in 36 patients. The mitral valve was affected in 77 patients, tricuspid valve in I patient and both miral and aortic valves in 6 patients. One patient died as a result of severe congestive cardiac failure. Twenty‐one patients had a recurrent attack. We observed that ARF is still a significant cause of morbidity in our country. As the disease is preventable by the eradication of streptococcus, we conclude that more effort should be made in the early detection and treatment of streptococcal infections.
Paediatrics and child psychiatry: past, present and future
Authors: Graham PJ
Published: January 2008

The historical development of the relationship between paediatrics and child psychiatry is outlined and the closer working relationships between the two disciplines over the past 30 years are noted. Various ways in which child psychiatrists can contribute to paediatric practice are described, as well as the degree to which paediatricians can contribute to an understanding of child psychiatric disorders. It is suggested that new developments in paediatric practice and an increase in interest in genetic and brain mechanisms in child psychiatric disorders, will increase the need for collaboration between the two specialties.
Collaboration between child psychiatry and paediatrics: the state of the relationship in Norway
Authors: Vandvik IH
Published: January 2008

In Norway, the first paediatric department was founded in Oslo 100 years ago. The first child psychiatric department was opened in 1950. To assess qualitative and quantitative aspects of child psychiatric liaison work, questionnaires were sent to the heads of 25 paediatric departments and 53 child psychiatric units. Scarce child psychiatric resources were spent in paediatrics. The average score for satisfaction with collaboration was moderate (5.5 on a 10‐cm visual analogue scale) and agreement between the parties was modest. Improvement will involve development of a common language and a shared model for understanding the psychosocial aspects of acute and chronic childhood illnesses. In‐service training for paediatricians in child psychiatry and vice versa may help. Both parties indicated a need for more training in consultation/liaison and in multi‐professional assessments and therapeutic interventions with children with physical illnesses.
Airway and body surface sensors for triggering in neonatal ventilation
Authors: John J , Björklund LJ , Svenningsen NW , Jonson B
Published: January 2008

Failure of neonatal patient triggered ventilation may reflect a delay in delivery of flow relative to the inspiratory effort of the infant. Transmission of diaphragmatic contraction to the sensor site (patient delay) and further transmission to and within the sensing device (device delay) both contribute to the delay in triggering. Patient and device delays were studied for different sensing systems in 36 infants, 24 of whom were intubated. Device delay was long (<40 ms) with a conventional apnoea monitor compared with sensors placed at the airway opening (2 ms), the inspiratory (12 ms) and expiratory (3 ms) pressure transducers of the ventilator, the Graseby capsule (8 ms), strain gauges (3 ms) and oesophageal pressure (6 ms). In near normal infants, the sum of patient and device delays for the latter sensors was less than 20 ms and a minor component of the total delay. However, in severe lung disease the total delay may be more than 100ms even for airway sensors.
Waist measurement correlates to a potentially atherogenic lipoprotein profile in obese 12–14–year‐old children
Authors: Flodmark CE , Sveger T , Nilsson‐Ehle P
Published: January 2008

Epidemiological studies have indicated a relationship between overweight and cardiovascular disease. The present investigation was undertaken to identify anthropometric variables in childhood which may reflect the risk of cardiovascular disease in terms of unfavourable changes in apolipoprotein and lipid concentrations. Twenty‐nine obese 14‐year‐olds and 32 obese 12‐year‐olds were recruited from a school screening programme and anthropometric data reflecting overweight and fat distribution were subjected to analysis of covariance, with blood pressure, apolipoprotein and lipid concentrations as dependent variables. Results from the two groups were adjusted for puberty, gender and screening group, allowing pooling of data. After such an adjustment, waist circumference was significantly correlated (r= partial correlation coefficient) to high density lipoprotein (HDL) cholesterol (r = ‐0.08, p < 0.05) and triglycerides (r=+0.24, p < 0.01). The waist:hip ratio was significantly correlated to HDL‐cholesterol (r= ‐0.10, p < 0.01) and triglycerides (r =+0.22, p < 0.01). BMI was significantly correlated to triglycerides (r=+0.25, p < 0.001), and diastolic blood pressure (r=+0.08, p < 0.05). The partial regression coefficients for waist circumference versus apolipoprotein B (r=+0.07) and the apolipoprotein B:A‐I ratio (r=+0.06) were as strong as those for waist:hip ratio (r=+0.03 and r=+0.05, respectively). Our results demonstrate that abdominal obesity is associated with an unfavourable lipid profile in obese 12–14‐year‐old children. This may be related to an increased cardiovascular risk later in life. The waist measurement appears to be a convenient and informative anthropometric indicator of such metabolic alterations.
Hydrops foetalis and chylothorax associated with superior caval vein obstruction and resolution following balloon dilatation
Authors: Adiotomre PNA , Burns JE , McIntosh N
Published: January 2008

A female infant (33 weeks' gestation) was delivered by emergency caesarean section because of hydrops foetalis. No cause was identified initially; haemoglobin, liver and renal functions were normal and there was no evidence of sepsis or significant myocardial dysfunction or arrhythmia. There was initial improvement with conventional management but bilateral pleural effusions persisted, which became overtly chylous after institution of enteral formula feeds on day 4. At 5 weeks of age, an obstruction at the superior caval vein/right atrial junction was confirmed at angiography and dilated with resolution of all remaining oedema and fluid collections. Repeat venography at 9 months of age showed a normal superior caval vein and she remains well at 15 months.
Hazards of ketoconazole therapy in testotoxicosis
Authors: Babovic‐Vuksanovic D , Donaldson MDC , Gibson NA , Wallace AM
Published: January 2008

An eight‐year‐old boy with Leydig cell hyperplasia (testotoxicosis) was admitted with a three‐day history of rash, vomiting and diarrhoea, followed by acute onset of breathlessness and confusion. He was shocked, with liver cell and renal failure, erythematous rash and severe interstitial pneumonitis. He had been treated with ketoconazole for four years prior to admission, receiving 1200mg daily during the preceding year. Cessation of ketoconazole therapy was associated with full clinical recovery but relapse of testotoxicosis. Ketoconazole was reintroduced cautiously at a lower dose, with no ill‐effect, and reasonable control of testotoxicosis. We conclude that this boy's illness, including the interstitial pneumonitis, represented a reaction to ketoconazole which was dose‐related rather than idiosyncratic.
Malignant liver disease in alpha1‐antitrypsin deficiency
Authors: Poley JR
Published: January 2008

Ever since the first report by Sharp et al. (1) that alpha1‐antitrypsin deficiency (AATD) PiZ is associated with liver disease in infants and children, hepatologists were captured by this association. Whereas the major manifestation of alpha1‐antitrypsin (AAT) PiZ deficiency in infants and children involves the liver, many adults affected with this phenotype develop chronic obstructive lung disease. However, in addition to severe panacinar emphysema, adults with AATD also face the risk of the development of chronic liver disease and hepatocellular carcinoma (HCC).
Diagnostic, preventive, medical and surgical management of alpha1‐antitrypsin deficiency in childhood
Authors: Burdelski M
Published: January 2008

Only 10 years ago the management of alpha1‐antitrypsin deficiency (AATD) as one of the most frequent hepatic‐based metabolic disorders in children had been restricted to diagnostic and palliative therapeutic aspects (1). After liver transplantation became an optional curative therapy in patients suffering from end‐stage liver disease (2), the transplantation of chronic end‐stage liver disease caused by AATD has extended to one of the most frequent indications in hepatic‐based metabolic disorders. Recently, new pathophysiological concepts of the development of liver damage in AATD have enabled us to examine optimized prevention therapy in this disorder (3, 4). This paper attempts to show how optimized therapy of affected children may be achieved.
Social policy and child health
Authors: Eisenberg L
Published: January 2008

Under the rubric of social policy and child mental health are two overlapping but conceptually different areas. The first set is the social policy questions with direct relevance to child mental health programs per se; that is, decisions about whether a given child mental health proposal merits the investment of community resources. The second category of social forces is that which has important secondary consequences for child mental health although child mental health per se may never enter the discussion; for example, policy decisions which have a major impact on family life (women's rights, tax policy, divorce law, employment policy, etc.). This paper will review the first category, the overt policy issues, before moving on to the second category, the “covert” child health debate.
Ontogeny of the gut‐associated lymphoid system in man
Authors: MacDonald Thomas T , Spencer Jo
Published: January 2008

Immunoperoxidase histochemistry using monoclonal antibodies to lymphoid/myeloid cells has been used to study the development of the human mucosal immune system in frozen sections of foetal human intestine at different ages. A steady progression of development was seen between 11 and 19 weeks' gestation. At 11 weeks, Peyer's patches were identifiable only as aggregates of strongly HLA‐DR+ cells. By 16 weeks these aggregates became colonized with T and B cells, without distinct cellular zonation. By 19 weeks primary B‐cell follicles were seen and T cells occupied the inter‐follicular zones. There was also a steady increase in the numbers of lamina propria and epithelial T cells between 11 and 19 weeks' gestation. As in postnatal bowel, CD8+ cells predominated in the epithelium and CD4 + cells predominated in the lamina propria. Thus the important T‐ and B‐cell compartments of the mucosal immune system are well established in the human foetal intestine by mid‐gestation.
Liver transplantation in children
Authors: Burdelski Martin
Published: January 2008

Liver transplantation has become the curative surgical therapy of end‐stage acute, chronic and metabolic liver disease. This has been made possible by improvements in surgical techniques, such as segmental liver transplantation and by improvements in liver preservation. In parallel, advances in immunosuppression and anti‐infective therapy have been achieved. As a result of this progress there is an increasing demand for liver transplantation which raises questions for ethical and socioeconomic consideration.
Oxygen free radicals and antioxidants in cystic fibrosis: the concept of an oxidant‐antioxidant imbalance
Authors: Winklhofer‐Roob Brigitte M
Published: January 2008

Patients with cystic fibrosis frequently exhibit increased oxygen free radical generation from activated neutrophils due to chronic lung inflammation on the one hand and antioxidant deficiencies due to exocrine pancreatic insufficiency on the other, resulting in an oxidant–antioxidant imbalance in favor of the former. As a consequence, free radical attack on unsaturated fatty acids of lipid structures leading to lipid peroxidation and damaging effects on proteins may occur. In the lung, antiproteases are thought to be inactivated by oxygen free radicals released from inflammatory cells. In the cholestatic liver, bile acids may propagate lipid peroxidation. An efficient antioxidant supply is suggested to control tissue injury by restoring the oxidant‐antioxidant balance. Mechanisms involved in the generation of oxygen free radicals are described and data on the antioxidant defense system in cystic fibrosis patients are presented, together with evidence of increased lipid peroxidation. Possible implications for disease processes are discussed as well as therapeutic concepts to reconstitute the oxidant‐antioxidant balance.
Remarks of a paediatrician on informed consent in children
Authors: Bender Steffen W
Published: January 2008

In medical practice, patients are frequently in a passive role with respect to consenting to medical measures. The basic threshold element of informed consent is medical competence to be controlled by individual self‐criticism. The elements of information, such as disclosure and understanding, have to be adapted to the individual situation in order to achieve voluntariness and active autonomous authorization. In the paediatric age group, disclosure of information has to be guided by the age‐dependent ability of understanding, leading to voluntariness and consent. Since force cannot be totally avoided in the management of children, parental information and consent should be as precise and conclusive as possible. The interaction between the paediatrician on the one hand, and the children and their parents on the other, is discussed.
Regulation of hemodynamics and oxygenation in developing intestine: insight into the pathogenesis of necrotizing enterocolitis
Authors: Crissinger KD
Published: January 2008

The pathogenesis of necrotizing enterocolitis remains unknown, but various factors have been postulated including, but not limited to, mesenteric ischemia, enteral alimentation, and infection. Since an understanding of circulatory physiology in developing intestine may provide insight into the role of mesenteric ischemia in the etiology of necrotizing enterocolitis, this review summarizes what is currently known about the regulation of blood flow and oxygenation in developing intestine and how it differs from that in adult intestine. The discussion is divided into intrinsic versus extrinsic factors. Phenomena which may be used to evaluate the capacity for intrinsic vasoregulation include pressure‐flow autoregulation, reactive hyperemia, venous hypertension, arterial hypoxemia, and postprandial hyperemia. Extrinsic factors include neurologic and hormonal influences. Additionally, the susceptibility for tissue hypoxia as a function of age and the correlation with subsequent development of mucosal injury are discussed
A study of pre‐antibiotic bacteriology in 125 patients with necrotizing enterocolitis
Authors: Chan KL , Saing H , Yung RWH , Yeung YP , Tsoi NS
Published: January 2008

Over a five‐year period, 125 newborns with necrotizing enterocolitis (NEC) were managed by us. Their mean birthweight was 1700 g and mean maturity was 32 weeks. Before commencement of antibiotics, routine septic work‐up was done in order to define the bacterial spectrum and antibiotic sensitivity. The study includes aerobic and anaerobic cultures of gastric and pharyngeal aspirates, blood cultures, umbilical swabs and culture of umbilical catheter tips in relevant cases. Peritoneal swab results were also analyzed if laparotomy was performed. Positive cultures were present in 45 patients (36%) with 55 positive specimens. Fifteen types of organism were isolated: the commonest was Enterobacter (29%), followed by E. coli (14.5%) and Klebsiella (13%). They were resistant to ampicillin and first‐generation cephalosporin. These organisms were usually opportunistic pathogens. Overgrowth of them may be the cause of NEC. Regular review of the antibiotic sensitivity of these organisms allows prompt and appropriate choice of antibiotics. At the same time, antibiotic sensitivity for these organisms was analyzed to guide us in the choice of antibiotic therapy.
Risk factors and severity indices in necrotizing enterocolitis
Authors: Schober PH , Nassiri J
Published: January 2008

In retrospective analysis we set up a chart review of 61 consecutively newborn infants with proven diagnosis of ants were admitted to the intensive care unit of the Department of Pediatric Surgery from 1985 to 1991. Birth weights varied from 790 to 4680 g (mean value 2408 ± 853), gestational ages from 27 to 43 weeks (mean value 36 ± 4.0); 33 patients received conservative treatment and 28 patients were operated on. An analysis of operated (group 1) and conservatively (group 2) treated patients revealed no statistically significant difference in birth weight, gestational age, peripartal complicanecrotizing enterocolitis. The 26 female and 35 male inftions or type of feeding. Yet a few parameters measured at admission remained as severity indices. Operated babies had significantly higher counts of immature granulocytes and an elevation in the I:T‐ratio, as well as lower counts of total granulocytes, lymphocytes, platelets and lower weights of the placenta. However, when taking into account the gestational age, the results showed that these parameters became insignificant in the low birthweight group below 34 weeks, and were of higher validity in the gestational age group over 35 weeks. In the latter group, C‐reactive protein also proved to be a good parameter with statistical significance respecting the severity of necrotizing enterocolitis.
Early relationships as regulators of infant physiology and behavior
Authors: Hofer Myron A
Published: January 2008

In recent years, animal research has revealed a network of simple behavioral and biological processes that underlie the psychological constructs we use to define early social relationships. Hidden within the observable interactions of parent and offspring are sensorimotor, thermal and nutrient‐based events which have unexpected and widespread regulatory effects on infant behavior and physiology. The complex pattern of responses resulting from early separation in infant rats can be traced to the abrupt withdrawal of a number of discrete, independent regulatory processes which had been acting on individual components of the infant's physiology and behavior. These regulatory processes also appear to mediate long‐term shaping effects exerted by early relationships, for example, on the vulnerability of the adult rat to hypertension and stress ulcer. In human development, early regulatory interactions may provide a bridge between biological and psychological processes in the development of our earliest mental representations.
Brain opioids and mother—infant social motivation
Authors: Panksepp Jaak , Nelson Eric , Siviy Steve
Published: January 2008

Brain opioids were the first neurochemical system to be implicated in the elaboration of socialbonding processes. Although a variety of neurochemical systems help elaborate social rewards and specific social behaviors, the role of opioids in the control of maternal behavior remains controversial. Although a great deal of data indicate that intermediate doses of morphine can reduce maternal behavior, the evidence, taken together, suggests that endogeneous opioids promote the regulatory control of maternal behavior, probably by providing feedback concerning the satisfaction that can be had from indulging in various maternal behaviors. Thus opioid blockade with naltrexone can reduce maternal competence in animals, while at the same time increasing maternal motivation. Opiate blockade likewise appears to increase the social motivation of rat pups, but reduces the reinforcing quality of interaction with the mother, suggesting that opioids provide feedback concerning the pleasurable qualities of social interaction in both mothers and infants. The clinical implications of this knowledge are not straightforward, but they generally suggest that clinically deficient social bonding might be capable of being strengthened via manipulation of brain opioid systems.