bluuebunny/crossref_metadata_2025 huggingface dataset:
Parental and primary care physicians’views on the management of chronic diseases: a study in Italy
Authors: Marchetti F , Bonati M , Marfisi RM , Gamba G La , Biasini GC , Tognoni G
Published: January 2008

A survey on the burden and quality of care and the parental and primary care physicians’views on management of eight chronic illnesses and disabilities was conducted from 1990 to 1993. Data were collected on 993 children and adolescents from family interviews and physicians’postal questionnaires. Approximately 70% of patients used two or more services for care management and 149 children were treated outside their region. Only 36% of the physicians were case managers and half of these agreed that better communication with other care providers could facilitate their role. A wide difference in parental satisfaction was found between medical and disabling conditions. Approximately 90% of the parents expressed satisfaction with care for children with coeliac disease (112/120), asthma (80/89) and diabetes (98/111), whereas approximately one‐third of parents of children with cerebral palsy and Down's syndrome were dissatisfied (88/242 and 72/189, respectively). Primary care physicians expressed similar satisfaction with case management. Distance from hospital, the need for more information on disease management and financial aid were the sources of greatest dissatisfaction. Children with disabling diseases had more problems integrating at school than children with other chronic disorders. Closer interaction between health services, providers and families is necessary to manage the needs of disabled (Italian) children better.Chronic illness, disability, family, primary care, quality of care, special needs
Prediction of complications following unintentional caustic ingestion in children. Is endoscopy always necessary?
Authors: Christesen HBT
Published: January 2008

The records of 115 children hospitalized following caustic ingestion over an 18.5‐year period from 1976 to 1994 were reviewed. The relationship between types of product ingested, signs and symptoms, degree of esophageal injury and complications was analyzed. All complications were the result of strong alkali ingestion (sensitivity = 1.0). Among the 102 incident patients, 36.8% of lye ingestions resulted in complications, whereas only 2.7% (one) of automatic dishwasher detergent (ADD) ingestions caused any complications (p < 0.01). Endoscopy 6h to 4 days after injury was accurate in predicting or identifying complications in all types of strong alkali ingestions. In lye ingestions, endoscopy was not superior to the test, “one or more signs or symptoms” in predicting complications (predictivity = 1.0). Endoscopy is recommended to establish or confirm a prognosis, or to identify acute respiratory complications, in symptomatic ingestions of lye or ammonia water, in children with respiratory symptoms, and in rare cases of severe symptoms following ADD or strong acid ingestion. It is suggested that children who are non‐symptomatic following unintentional ingestions are not at risk of complications and do not need endoscopic examination. Causlic ingestion, children, complication, diagnostic test, endoscopy, esophagus, unintentional
Growth promotion by oxandrolone in a girl with short stature and early pubertal development treated with growth hormone and gonadotropin‐releasing hormone‐analogue. A case study
Authors: Hermanussen M
Published: January 2008

Gonadotropin‐releasing hormone (GnRH)‐analogues are widely used for treating precocious puberty, and occasionally in short patients and patients with growth‐hormone deficiency, in order to delay pubertal development and increase final height. Yet, many of these children only decelerate growth velocity and neither improve in final height nor even in height prediction. As GnRH‐analogue treatment dramatically reduces sexual steroid levels, I hypothesized the need for steroid hormone substitution during this treatment. Growth promotion was tried in a healthy girl, with a very unsatisfying height prediction of only 144 cm, using a combination of GnRH‐analogue (75 /μg/kg/4 weeks), plus growth hormone (4 IU/m
Development of human peripheral hearing revealed by brainstem auditory evoked potentials
Authors: Jiang ZD , Tierney TS
Published: January 2008

Development of human peripheral hearing from birth to 6 years was investigated by recording brainstem auditory evoked potentials (BAEPs). The threshold of BAEPs decreased rapidly during the first 3 months after birth (2.7dB/week during the neonatal period, 2.6dB/month at 1‐3 months), after which further decrease occurred more slowly but continued through 1 year of age (0.26 dB/month at 3‐12 months). A few days after birth, the threshold was 18 dB higher compared to the adults, and progressively decreased to 10, 5 and 2 dB at 1, 3 and 12 months, respectively. The latencies of waves I and V decreased as a function of age at a rate of 0.01 and 0.05 ms/week during the neonatal period, 0.02 and 0.10ms/month at 1‐3 months and 0.014 and 0.076 ms/month at 3‐12 months, respectively. Adult latency value was attained by 2 and 4 years for waves I and V, respectively. These findings suggest that although the ear is reported to be almost adult‐like at birth, the immaturity in neural functional properties limits auditory sensitivity during early childhood. It appears that human peripheral hearing threshold decreases rapidly through the third postnatal month and thereafter continues to improve slowly through early childhood. It is postulated that the first 3 months after birth are likely to be a critical period in postnatal development of human peripheral hearing.
Body growth in children with polycystic kidney disease
Authors: Konrad M , Zerres K , Wühl E , Rudnik‐Schöneborn S , Holtkamp U , Schärer K , Für Pädiatrische Nephrologie Arbeitsgemeinschaft
Published: January 2008

We analysed the body growth of 121 prepubertal children with polycystic kidney disease participating in a longitudinal multicentre study. The patients were followed from an age of 1 to 9 years in girls and 1 to 10 years in boys over a mean period of 3.6 years. Children with end‐stage renal disease were excluded. Fifty‐four patients had the autosomal dominant form of the disease and 67 the autosomal recessive form. At last observation, 2% of patients with the dominant form and 28% of those with the recessive form had an estimated glomerular filtration rate of < 60 ml/(min 1.73 m2). At first observation, the mean height SD score (SDS) in patients with the dominant form was almost the same as in controls, whilst in those with the recessive form it was significantly decreased (girls –0.82 SDS, boys ‐0.68 SDS,p < 0.001). During the follow‐up the height SDS decreased slightly in both groups (NS). In patients with autosomal recessive kidney disease the degree of growth retardation appeared to be related to renal function: at last observation the height of girls with an estimated glomerular filtration rate of < 60ml/(min 1.73 m2) was more retarded than that of boys (mean ‐2.1 SDS versus ‐1.5 SDS, NS). The height SDS and renal function at last observation correlated in girls (r= 0.83, p < 0.001) but not in boys (r= 0.55) with the recessive form. No correlation was found between the height SDS and hypertension. The weight‐for‐height SDS at onset was significantly reduced in patients with the recessive form with decreased renal function. Our data suggest that the autosomal recessive, but not the dominant, form of polycystic kidney disease is associated with early growth retardation, which seems to be more severe in girls, probably due to the more rapid deterioration of renal function.
IgA bovine serum albumin antibodies are increased in newly diagnosed patients with insulin‐dependent diabetes mellitus, but the increase is not an independent risk factor for diabetes
Authors: Saukkonen T , Savilahti E , Landin‐Olsson M , Dahlquist G
Published: January 2008

We studied the significance of antibodies to bovine serum albumin (BSA) as a risk factor for insulin‐dependent diabetes mellitus (IDDM) in a case‐control setting. IgA and IgG antibodies to BSA and ovalbumin were measured from sera of 104 patients with newly diagnosed IDDM and of 111 matched controls by enzyme‐linked immunosorbent assay. Patients with diabetes had significantly higher levels of IgA antibodies to BSA (p= 0.003); IgG antibodies also tended to be higher (p= 0.08). Levels of IgA antibodies to ovalbumin were similar in the patients and controls, but IgG antibodies were higher in controls (p= 0.02). When antibodies to BSA, β‐lactoglobulin, whole cow's milk and islet cell antibodies were studied as risk determinants of IDDM in a multivariate, logistic regression analysis, IgA antibodies to β‐lactoglobulin and to cow's milk were independently associated with the risk (p= 0.037 and 0.048, respectively), while antibodies to BSA were not a significant risk factor. The results question the role of BSA as a cross‐reacting antigen with pancreatic β‐cell surface proteins in the aetiology of IDDM.
γδ lymphocytes in mumps meningitis patients
Authors: Bertotto A , Spinozzi F , Gerli R , Bassotti G , Forenza N , Pazzelli P , Bartolucci M , Giorgi G De , Vaccaro R
Published: January 2008

Flowcytometric analysis on T‐cell subpopulations in the blood and cerebrospinal fluid (CSF) of 10 children with mumps meningitis (MM) revealed that the proportion of lymphocytes which bore the γδ T‐cell receptor for antigen was significantly higher in CSF than in autologous and heterologous blood samples. γδ T‐cell values in CSF of MM patients were also significantly higher than those calculated in CSF specimens from nine children with non‐inflammatory neurological disorders. Whether and how the expanded CSF γδ T‐lymphocyte subset, either CD8 + or double‐negative (CD4‐/CD8‐), contributes to the eradication of mumps virus infection from the central nervous system represents a central focus of our ongoing research.
An assessment of sources of information in post‐perinatal infant death reviews
Authors: Newlands M , Emery JL
Published: January 2008

The objective of this study was to identify adverse social and medical factors contributory to post‐perinatal deaths and at which stage of the case study each factor was found. The sources of information assessed were: (i) recorded data from case notes, laboratory and postmortem findings, and (ii) created information from (a) home interview and (b) case discussion held in the family doctor's office. The deaths were categorized into seven clinicopathological groups and adverse factors into general demographic and personal psychosocial. Among the 87 sequential post‐perinatal infant deaths, 325 adverse factors were identified; of these, 125 (38%) were judged to be actionable by the carers. Of 183 (56%) adverse factors found in the case notes, only 36 were actionable. Forty‐five more adverse factors were found at home interview; 26 (58%) of these were actionable. At case discussion another 97 adverse factors were revealed; 63 (65%) were actionable, thus proving the most important source of actionable information.
Influence of body temperature on thyrotropic hormone release and lipolysis in the newborn infant
Authors: Marchini G , Persson B , Jonsson N , Marcus C
Published: January 2008

The present study investigated possible interactions between body temperature, lipolysis and thyrotropin (TSH), the only hormone with a documented lipolytic effect in vitro in newborn infants. Healthy infants were either nursed in the usual way (n= 18) or protected from a decrease in body temperature (n= 17) during the first postnatal hour. The infants’axillary temperatures were measured immediately after birth and after 10 and 60 min. Blood samples were collected from the umbilical vein and from the infants 10 and 60 min after birth for analysis of TSH, glycerol, free fatty acids, 3‐OH‐butyric acid and glucose. We found that the mean (±SD) infant axillary temperature was 37.6 ± 0.4oC immediately after birth. In the routinely nursed infants, body temperature decreased to 37.0 ± 0.5oC at 10 min (p= 0.01) and to 36.6 ± 0.4oC at 60 min (p= 0.01); the cold‐protected infants maintained their fetal temperature at 60 min of age. There was a four‐fold increase in plasma TSH levels at 10 min, independent of the infant's body temperature, and the hormone level remained invariably high at 60 min. Plasma glycerol levels increased progressively at 10 min (p= 0.01) and 60 min (p= 0.01) in both infant groups, but were higher (p= 0.02) in the routinely nursed infants at 60 min. No significant relationship was found between TSH and glycerol levels. Infant body temperature did not affect the levels of free fatty acids, 3‐OH‐butyric acid or glucose. We conclude that the change in environmental temperature as a result of extrauterine adaptation causes thermal stimulation of the infant's body surface which leads to activation of the hypothalamic‐pituitary TSH axis, resulting in maximal TSH release, and thus to induction of the lipolytic process. A decrease in body temperature may be an additive stimulus for further enhancement of lipolysis.
Early [18F]FDG positron emission tomography in infants with hypoxic‐ischaemic encephalopathy shows hypermetabolism during the postasphyctic period
Authors: Blennow M , Ingvar M , Lagercrantz H , Stone‐Elander S , Eriksson L , Forssberg H , Ericson K , Flodmark O
Published: January 2008

Six full‐term infants suffering from perinatal asphyxia and with moderate or severe hypoxic‐ischaemic encephalopathy were investigated by positron emission tomography (PET). Regional cerebral metabolic rates of glucose (rCMRgi) were determined using [2‐18F]2‐fluoro‐2‐deoxy‐D‐glucose ([18F]FDG) PET scans at a median age of 2.5 days (range 2‐5 days). Localized increases in rCMRgi were visually observed in five infants. In a subgroup of three infants, absolute values of rCMRgl in different brain regions were calculated. In all cases the results of the PET studies were in good agreement with those of the neuroradiological, neurophysiological and clinical investigations. Information indicating pathophysiological events could be extracted earlier with PET than with conventional morphological imaging techniques. We conclude that [18F]FDG‐PET scans performed in critically ill, asphyxiated infants very soon after birth provide valuable information for the prediction about neurological outcome.
Early protein oxidation in the neonatal lung is related to development of chronic lung disease
Authors: Varsila E , Pesonen E , Andersson S
Published: January 2008

Free radical‐mediated oxidation of proteins may impair their function and cause cellular damage. We studied pulmonary protein oxidation and its association with the development of chronic lung disease in 61 newborn infants (mean gestational age 31.1 ± 4.0, range 24‐41 weeks) requiring intensive care with oxygen therapy. Protein oxidation was quantified as protein carbonylation in tracheal aspirates recovered daily during the first week of life. Mean carbonyl concentration was 3.5 ± 1.6 μmol/mg protein. Negative correlations existed between protein carbonylation during days 2‐4 and gestational age (day 2: r= ‐0.37, p= 0.01; day 3: r= ‐0.48, p= 0.001; and day 4: r= ‐0.33, p= 0.03). Patients who developed bronchopulmonary dysplasia showed significantly higher protein carbonylation on days 1‐6 (all p < 0.05). In multiple regression analysis explaining bronchopulmonary dysplasia, using gestational age, inspired oxygen on days 1‐3 and protein carbonylation on day 3 as independent variables, only protein carbonylation remained significant. We conclude that immaturity is the most important factor explaining free radical‐mediated pulmonary protein oxidation in newborn infants and that oxidation of proteins is related to the development of chronic lung disease.
Circulatory effects of ventilator rate and end‐expiratory pressure in unparalysed preterm infants
Authors: Bohin S , Fenton AC , Thompson JR , Evans DH , Field DJ
Published: January 2008

Impairment of cerebrovascular autoregulation may be important in the pathogenesis of ischaemic brain injury in preterm infants. A previous study in ventilated preterm infants paralysed with pancuronium showed that changes in cerebral blood flow velocity (CBFV) were related to concomitant changes in arterial blood pressure. In a similar study in unparalysed infants, changes in CBFV in response to changes in ventilator rate or end‐expiratory pressure were independent of associated changes in the arterial blood pressure. These results emphasize the importance of avoiding large swings in blood pressure in paralysed infants. Whether alternative paralysing agents have similar effects warrants further study.
Severe Rh(D) immunization: anti‐D quantitation and treatment possibilities during pregnancy and after birth
Authors: Gottvall T , Hilden J‐O , Nelson N , Filbey D
Published: January 2008

An extremely aggressive Rh(D), (C) and Kell alloimmunization during pregnancy is reported. Exceptionally high concentrations of anti‐D were observed in the mother, in the fetus and in the amniotic fluid, indicating an active transport across the placenta and a passive excretion into the amniotic fluid. Treatment during pregnancy included maternal plasmapheresis and high‐dose intravenous immunoglobulin. Intravascular transfusions were given to the fetus. Postpartum the newborn was given immunoglobulin, one exchange transfusion and four top‐up transfusions. In the newborn the elimination rate of anti‐D could be followed. Not until almost 4 months postpartum did the anti‐D concentration drop below the level of detection. This coincided with an elevated reticulocyte production and appearance of the child's true blood group in parallel with ceasing need for blood transfusions. Elimination rate and absolute anti‐D values can be used as a prognostic tool to predict the need of blood transfusions. Immunoglobulin treatment can also be considered as an optional form of treatment in newborns affected by alloimmunization.
Imperforate anus, bilateral hydronephrosis, bilateral undescended testes and pituitary hypoplasia: a variant of Hall‐Pallister syndrome or a new syndrome?
Authors: Cianfarani S , Vitale S , Stanhope R , Boscherini B
Published: January 2008

A patient with multiple congenital malformations, including imperforate anus, bilateral cryptorchidism and microphallus, is described. At 4 months of age the infant had generalized convulsions and hypoglycaemia. Bilateral hydronephrosis was diagnosed at 8 months of age. At 10 months he was diagnosed as having panhypopituitarism secondary to anterior pituitary hypoplasia, shown on CT and MRI scans. This clinical picture partially resembles that of Hall‐Pallister syndrome. However, the absence of some typical features such as craniofacial and limb abnormalities and, above all, hypothalamic hamartoblastoma, would also suggest the possibility of a new, previously unreported, syndrome.
Quality of life among young adults born with very low birth weights
Authors: Bjerager M , Steensberg J , Greisen G
Published: January 2008

Quality of life (QoL) was assessed in 85 young adults, born in 1971–1974 with birthweights < 1500g (VLBW) and admitted to the neonatal intensive care unit of the State University Hospital in Copenhagen, Denmark. Their QoL was compared to that of 85 subjects with birthweights >2500g (NBW) born in the same period at the State University Hospital. The subjects were interviewed by telephone on the basis of the well‐defined theories on QoL by Anton Aggernss. Quality of life was assessed both in objective terms and as judged by the interviewed person. Subjects born with VLBWs and free of handicaps had QoL scores (both objective and subjective) fully comparable with the NBW group. VLBW subjects reporting various physical and mental handicaps had objective as well as subjective QoL scores significantly lower than the NBW group.
Impact of chronic undernutrition on higher mental functions in Indian boys aged 10–12 years
Authors: Agarwal KN , Agarwal DK , Upadhyay SK
Published: January 2008

Undernourished rural children 10–12 years of age demonstrated the following, when compared to normal nourished children: (i) a relative deficit of memory quotients assessed by the Wechsler memory scale; (ii) lower scores for abilities related to personal and current information, orientation, mental control, logical memory, digit span, visual reproduction and associative learning; (iii) impaired set formation and flexibility in attention as assessed by the card sorting test; and (iv) impairment in conditional learning on maze and conditional associative learning tests. The performance on the finger dexterity test for fine motor coordination was not affected in undernourished children.
The role of small bowel radiology in the diagnosis and management of Crohn's disease
Authors: Halligan S , Nicholls S , Beattie RM , Saunders BP , Williams CB , Walker‐Smith JA , Bartram CI
Published: January 2008

A total of 50 children with Crohn's disease were examined by barium follow‐through and colonoscopy with ileoscopy, to determine the value of small bowel radiology. Of these children, 40 (80%) had evidence of small bowel Crohn's disease on ileoscopy and/or barium follow‐through. Twenty‐two (44%) had disease confined to the terminal ileum. Radiology diagnosed disease proximal to the terminal ileum in 18 cases (36%), including 5 children in whom the terminal ileum was normal. Ileoscopy was not possible in nine patients (18%), six of whom had small bowel disease on barium follow‐through. Colonic involvement, demonstrated in 34 (68%), was the sole site of disease in 6 (12%). Fifteen (30%) children had surgery, which in six (12%) was determined by the radiological findings of complicated small bowel disease. As the terminal ileum may be uninvolved in the presence of proximal ileal disease, normal ileoscopy does not exclude small bowel Crohn's disease. Small bowel radiology remains necessary to assess the full extent of Crohn's disease in children.
Cerebral and ventilatory depression during hypoxia in anaesthetized newborn guinea‐pigs
Authors: Yuan Shi‐Zeng , Runold Michael , Lagercrantz Hugo
Published: January 2008

The effects of hypoxia on ventilation and cerebral activity were studied in urethane‐anaesthetized newborn guinea‐pigs. Ventilation was measured by a pneumotachograph, and cerebral activity by a cerebral function monitor (CFM). All animals were subjected to either 9% O2 or 6% O2 in N2 for 10 minutes or until apnoea occurred. Hypoxia produced a biphasic response in ventilation, that is, an increase followed by a decrease. The initial increase was attributed to the elevation of the respiratory rate, whereas the tidal volume showed a pure decline. The respiratory rate reached its peak at 3 minutes of hypoxia (170 ± 12% during 9% O2 and 169 ± 12% during 6% O2). Cerebral activity during both 9 and 6% O2 breathing showed a small increase followed by a decrease. In the group subjected to 9% O2 the maximum CFM activity increased to 114 ± 8% of the control level and the minimum activity increased to 113 ± 7%, while in the group subjected to 6% O2 the maximum CFM activity increased to 104 ± 5% and the minimum CFM activity to 101 ± 3%. The depression of CFM activity was more pronounced with 6% O2 than with 9% O2. Regression analysis showed a linear correlation between ventilation and cerebral activity during both 9 and 6% O2 breathing. The results suggest that hypoxic ventilatory depression may be the consequence of cerebral depression produced by acute severe hypoxia.
Diffuse juvenile non‐adenomatous polyposis: a rare cause of severe hypoalbuminaemia in childhood
Authors: Nicholls S , Smith V , Davies R , Doig C , Thomas A , Miller V
Published: January 2008

Hypoalbuminaemia is a well‐recognized complication of juvenile polyposis, which is often not clinically apparent. We describe a child with diffuse colonic non‐adenomatous polyposis who presented with generalized oedema and severe hypoalbuminaemia. The site of the protein loss was the polyps, and the problem resolved after colectomy. This is a case of unusually severe hypoalbuminaemia complicating juvenile polyposis.
Influence on fetal growth of exposure to tobacco smoke during pregnancy
Authors: Roquer JM , Figueras J , Botet F , Jimenez R
Published: January 2008

We analysed the effect of exposure to tobacco smoke during pregnancy on fetal growth parameters in 129 term newborns. Children were classified into four depending on exposure on the basis of a questionnaire completed by the mother. The results confirmed that tobacco smoking reduced weight, length, cranial and thoracic perimeters at birth when exposure was due to either active or passive smoking. Weight deficits of infants whose mothers smoked heavily (458 g) were higher than those whose mothers were exposed to passive smoking (192 g). We conclude that passive smoking is a very important variable and should be taken into account in any study of neonatal growth parameters.
Immunoglobulin levels and lymphocyte response to mitogenic stimulation in children with malignant disease during treatment and follow‐up
Authors: Abrahamsson J , Marky I , Mellander L
Published: January 2008

Intensification of chemotherapeutic regimens has improved survival in childhood malignant disease. To characterize the impact of this intensified therapy on some aspects of the immune system, we have, in an unselected material of 220 children with malignant disease, investigated serum immunoglobulin levels and lymphocyte response at diagnosis and then subsequently during and up to 4 years after cessation of therapy. In leukemia and Hodgkin's disease, all immunoglobulin isotypes decreased during therapy. A profound depression of immunoglobulin M levels, lasting well after completion of therapy, was seen in all tumor types. The mitogenic response was attenuated in patients with leukemia at diagnosis but was rapidly restored after institution of therapy. Patients with solid tumors, particularly Hodgkin's disease, had a reduced mitogenic response during therapy. Thus these patients exhibit multiple immunological disturbances. The basis of the pronounced immunoglobulin M deficiency remains unclear.
Diarrhoeal outbreak of Vibrio cholerae 0139 from North India
Authors: Gomber S , Mathur M , Sharma PP
Published: January 2008

Epidemics of cholera caused by Vibrio cholerae 01 occur regularly in India. Until recently, Vibrio cholerae non‐01 have been the the causative agents of sporadic cases of gastroenteritis and septicaemia, especially in immunocompromised children. We describe a large outbreak of cholera‐like illness from North India caused by Vibrio cholerae non‐01, later serotyped as Vibrio cholerae 0139. Forty‐one of a total of 391 patients with acute diarrhoea during a 2‐month period (May–July 1993) were identified as having Vibrio cholerae in faecal samples. All patients were aged 1.5–12 years. Vibrio cholerae 0139 was isolated in 30 patients (73%–group I) and Vibrio cholerae 01 biotype eltor in 11 patients (27%–group II). The clinical presentation and severity of the cholera‐like illness were similar to typical cholera. This strain is toxigenic with an epidemic potential and should be monitored carefully □
Severe mental retardation in 2 to 24‐month‐old children in Lahore, Pakistan: a prospective cohort study
Authors: Yaqoob M , Bashir A , Tareen K , Gustavson K‐H , Nazir R , Jalil F , Döbeln U von , Ferngren H
Published: January 2008

Severe mental retardation (developmental quotient (DQ) < 50) was investigated in 1303 children from 2 to 24 months of age, born during 1984‐87 in four population groups representing different socioeconomic levels in and around Lahore, Pakistan. The incidence per 1000 live births was 22 in the periurban slum, 9 in the urban slum, 7 in the village and 4 in the upper middle class group. The aetiology was prenatal in 79%, perinatal in 14% and untraceable in 7% of cases. Down's syndrome was the most common cause of severe mental retardation (36%). Impairments were studied at 2 years of age. Impairment of language was present in all, while locomotor dysfunction was seen in 89% of cases. Epilepsy and cerebral palsy were each present in 22% of cases. Mortality among these severely mentally retarded children was 36%.
Persistent non‐familial asymptomatic hyperphosphatasemia: a report on three cases
Authors: Asami T , Gomi T , Uchiyama M
Published: January 2008

Three male children, aged 9 days, 2 years and 13 years, were found to have elevated serum alkaline phosphatase (ALP) activity (hyperphosphatasemia) in the absence of disease. In these three cases, elevation of ALP activity had persisted for 6‐10 years. These patients did not inherit the disease from their parents. Isoenzyme determination revealed a skeletal origin of the elevated ALP in the three patients. They were diagnosed as having persistent non‐familial asymptomatic hyperphosphatasemia (PNAH) which differs from transient and persistent asymptomatic familial hyperphosphatasemia. Reviewing the literature, although the term PNAH had not been used, two similar cases have been reported in a 24‐year‐old female and in a 27‐year‐old female. PNAH may be another type of benign hyperphosphatasemia.
Cord blood cells and indices: smoking–related differences between the sexes
Authors: Mercelina–Roumans PEAM , Breukers RBGE , Ubachs JMH , Wersch JWJ van
Published: January 2008

The values of whole blood cell count, leucocyte differential, and platelet and reticulocyte counts were determined in cord blood of both male (n= 64) and female (n= 75) newborns of 87 non–smoking and 52 smoking mothers. Leucocytes and neutrophils in cord blood from the male newborns of smokers were significantly lower than those in their female counterparts and in male newborns of non–smokers. These results suggest that male newborns are more affected by cigarette exposure than females with regard to some haematological parameters.
Does age at the start of breast feeding influence infantile diarrhoea morbidity? A case–control study in periurban Guinea–Bissau
Authors: Gunnlaugsson G , Silva MC da , Smedman L
Published: January 2008

Colostrum protects the newborn from intestinal infection by its content of secretory immunoglobulin A and other immediately acting factors. It may also induce maturation of the child's gastrointestinal immune defences, thus contributing to the protection against diarrhoeal disease later in infancy. To test this hypothesis, a case–control study on breast feeding and diarrhoea was carried out in a periurban community in Guinea–Bissau. The child's age at the start of breast feeding was ascertained soon after birth (n = 279). Subsequent cases of acute diarrhoea (n = 66) were identified at 3–monthly examinations, and four concurrent controls were randomly selected among attendants. Three separate estimates of association showed that the cases tended to have started breast feeding later after birth than the diarrhoea–free controls, but no single test was statistically significant. Early breast feeding might have consequences for diarrhoeal morbidity after the neonatal period.
Neuropsychological deficits in very young bone marrow transplant recipients
Authors: Smedler A–C , Bolme P
Published: January 2008

Bone marrow transplantation (BMT) involves conditioning with cyclophosphamide and, for patients with malignant disease, total body irradiation (TBI). This study describes the neuropsychological development of 10 children treated for leukemia(n= 7), neuroblastoma(n =1) or severe aplastic anemia (SAA;n =2) at 3 years of age or younger. A moderate general developmental delay, with pronounced motor deficits and varying degrees of perceptual and cognitive problems, was observed in all children treated for malignant disease. Children treated for SAA had normal development. We conclude that BMT, including TBI, can be directly associated with long–term neuropsychological impairment in children treated at a very young age. Continued medical and psychological follow–up procedures are needed.
Healthy eating for infants–mothers’attitudes
Authors: Morgan Jane B , Kimber AC , Redfern AM , Stordy BJ
Published: January 2008

Mothers’perceptions of desirable nutritional practices in infant feeding were examined using a questionnaire consisting of open and closed questions. A total of 1004 mother–infant pairs were recruited from a mixture of urban and rural areas in England. The sample represented a cross–section of socioeconomic groups and educational backgrounds. Mothers’attitudes to healthy eating for infants revealed some misconceptions; 83% felt that a high fibre intake was important or very important and 87% that a low fat intake was important or very important, while 20% considered that plenty of calories was not important. Other health guidelines were appropriately applied and most mothers considered a wide variety of foods, plenty to drink and a low sugar and salt intake to be important. These beliefs were representative of the sample population, irrespective of the socioeconomic group, location, age and education of the mother.
The nutritional response to home enteral nutrition in childhood
Authors: Papadopoulou A , Holden CE , Paul L , Sexton E , Booth IW
Published: January 2008

The nutritional response to home enteral nutrition (HEN) was evaluated in a prospective study of 44 consecutive children (median age 48 months) who received HEN for more than 1 month (median duration 6 months). Three groups were studied: 17 children were stunted, 14 were wasted and 13 were adequately nourished but unlikely to maintain oral intake during anticipated nutritional stress. In the stunted group (median duration of HEN 15 months) there was a significant correlation between improvements in height–for–age z scores and duration of feeds (r= 0.63; p= 0.006). In the wasted group (median duration of HEN 4 months) all anthropometric indices improved significantly (p < 0.05). HEN was also successful in maintaining nutritional status in the third group. Thus, supplementary HEN is an effective method of nutritional support for a variety of indications, provided concurrent advice from a nutritional care team is available.
Measurement of skin temperature and heat flow from skin in term newborn babies
Authors: Karlsson H , Händ S‐E , Nilsson K , Olegård R
Published: January 2008

Regional heat loss and skin temperature changes in 25 healthy, full‐term infants were studied under controlled conditions at environmental temperatures of 28‐32 oC. Skin temperatures for all body regions followed changes in operative temperatures. Regional dry heat losses closely followed the external temperature gradient (difference between skin and operative temperature). The technique allows measurement of regional dry heat loss from the newborn skin exposed to different environmental conditions for different body surface areas. Thermal conductance, as an index of cutaneous blood flow, was calculated in a subgroup of 8 of the 25 babies by decreasing the operative temperature by 3‐4 oC from the assumed thermoneutal zone. Thermal conductance indicated that only the foot responded to lower temperatures with vasoconstriction. Blood flow index of the chest region increased in all babies at lower temperature.
An 8‐year follow‐up of anti‐insulin antibodies in diabetic children: relation to insulin autoantibodies, HLA type, β‐cell function, clinical course and type of insulin therapy
Authors: Salardi S , Cacciari E , Steri L , Donati S , Mandini M , Gualandi S , Mantovani W , Zucchini S
Published: January 2008

In 105 children and adolescents with IDDM, insulin antibodies were detected as a percentage of radiolabelled insulin both at onset of disease and during the first 8 years of treatment. At diagnosis, 29 patients (27%) were insulin autoantibody positive (IAA+). An inverse relationship was found between IAA levels and age at diagnosis. No significant correlation was seen between IAA positivity and HLA antigens, while there was a negative correlation between IAA and C‐peptide levels in the second year of the disease. The percentage of insulin antibody (IA) positive patients increased after insulin administration, with a maximum peak between the first and second year of the disease. The IA response to insulin therapy was similar in IAA+ and IAA— patients, while it was greater in younger children. No relationship was found between IA levels and haemoglobin A1c values, daily insulin requirement, HLA and early complications. No difference in either percentage of positivity or IA levels was seen in patients treated continually for the first 5 years of the disease with monocomponent porcine insulin or human insulin. A negative correlation was found between IA and C‐peptide levels in the first and second years of the disease. In conclusion, we have shown that, even after many years of disease, neither IAA nor IA, induced in equal measures by current human insulin preparations, have significant effects on the clinical course of the disease.
Nosocomial gastroenteritis in two infant wards over 26 months
Authors: Bennet R , Hedlund KO , Ehrnst A , Eriksson M
Published: January 2008

We retrospectively reviewed 209 cases of nosocomial diarrhea in two infant wards at St Göran's Children's Hospital. They occurred from April 1987 to May 1989, when 3105 patients spent 26 355 hospital days. The hospital is a 250‐bed tertiary center with university affiliation. Fourteen percent of patients at risk developed nosocomial diarrhea, and the relative attack rate was 1.1 episodes per 100 hospital days. A probable viral etiology was found in 47% of patients. Rotavirus was most frequent and occurred during the community rotavirus seasons. Also small, round, structured viruses were common, and two outbreaks of astrovirus gastroenteritis occurred. Failure to detect a virus was particularly common among infants younger than 4 months. However, a seasonal distribution and peaks concordant with defined clusters in older patients, suggest also that some of these detection‐negative cases may have a viral etiology.
Latex allergy in a child with banana anaphylaxis
Authors: Cinquetti M , Peroni D , Vinco A , Zoppi G
Published: January 2008

Allergy to latex and to banana is probably uncommon. Cross‐reactivity between these two antigens has been recently demonstrated, but the clinical association of allergic reactions to latex contact and banana ingestion is extremely rare. We report a 3‐year‐old boy who developed an anaphylactic reaction following banana ingestion and who presented an associated immediate hypersensitivity to latex.
Changes in breastfeeding practices in Norwegian maternity wards: national surveys 1973, 1982 and 1991
Authors: Endresen E Heiberg , Helsing E
Published: January 2008

Total breastfeeding rates in Norway increased from <30% at 12 weeks in 1968 to >80% in 1991. Concomitant changes in routines related to breastfeeding in all Norwegian maternity wards were examined in 1973, 1982 and 1991. Head midwives responding to identical survey questionnaires described “usual practices” in their wards. The considerable changes over these 18 years reflected international recommendations such as those summarized in WHO/UNICEF's 1989 Joint Statement and “Ten steps to successful breastfeeding”. Undisturbed and prolonged contact between mother and baby became more common, as did more respect for the needs of the nursing couple, and more individualized care. In responses to open‐ended questions, many respondents expressed a positive attitude towards these changes, while “clusters” of negative attitudes were also seen. As research on inborn infant behaviour and mother‐infant interaction proceeds, the present survey suggests areas where further information may benefit both mothers and health workers. Breastfeeding, lactation management, maternity routines, national surveys, neonatal care
Iv gamma globulin treatment of Kawasaki disease in Japan: results of a nationwide survey
Authors: Yanagawa H , Yashiro M , Nakamura Y , Sakata K , Kawasaki T
Published: January 2008

The administration of iv gamma globulin (IVGG) for Kawasaki disease was investigated throughout Japan in 1993 by obtaining information from the pediatric departments of 2652 hospitals with more than 100 beds. A total of 1826 hospitals (68.9%) responded, reporting on 11 221 patients who were diagnosed during the survey period from January 1991 to December 1992. There were 8958 patients (79.8%) who received IVGG treatment. The most common treatment modality was 200mg/kg (29.6%), followed by 400mg/kg (18.7%) and 300mg/kg (12.9%), all for 5 days. The distributions of total dose were: 1000 mg/kg or less, 45.7%; 1001‐1500 mg/kg, 27.3%; and over 1500 mg/kg, 23.8%. For all patients to whom IVGG was administered, treatment was started in 53.8% by day 5 of illness and in 86.1 % by day 7. The proportion of those with cardiac sequelae was higher in patients who were treated with IVGG, possibly due to the fact that those who were more severely affected were more likely to be treated with IVGG. Epidemiology, gamma globulin treatment, Japan, Kawasaki disease
Achalasia with absent tear production
Authors: Mić‐Turk D , Tomaič D
Published: January 2008

We report the unusual and very rare association of achalasia with deficient tear production, which is probably an autosomal recessive inherited syndrome. The diagnosis of achalasia was confirmed by radiologic, endoscopic and endosonographic studies and the absent tear production by Schirmer's test. Achalasia, deficient tear production, endosonography
Effect of surfactant on nitroblue tetrazolium reduction of polymorphonuclear leucocytes stimulated with type la group B streptococci
Authors: Herting E , Jarstrand C , Rasool O , Curstedt T , Hakansson S , Robertson B
Published: January 2008

Activation of polymorphonuclear leucocytes (PMN) was investigated after incubation of adult human PMN and group B streptococci (GBS) type la with a type‐specific polyclonal antiserum and a modified porcine surfactant (Curosurf). The level of oxidative metabolism of PMN was studied using a micromethod modification of the nitroblue tetrazolium (NBT) reduction test. GBS alone did not stimulate significant oxygen metabolite release from PMN, and incubation of PMN with surfactant alone resulted in decreased NBT reduction. After opsonization of GBS with a specific antibody, PMN were activated and the increased oxygen metabolite release was not suppressed when surfactant was added to the system. We conclude that the encapsulated GBS strain investigated needs opsonization with specific antibody to increase oxidative metabolism of PMN, and that incubation of PMN and opsonized GBS with surfactant does not interfere with NBT reduction.Antibodies, nitroblue tetrazolium, polymorphonuclear leucocytes, pulmonary surfactants, streptococcus group B

E Herting, Research Unit for Experimental Perinatal Pathology, Department of Woman and Child Health, Karolinska Hospital LI/01, S‐171 76 Stockholm, Sweden
Sulphasalazine desensitization in a paediatric patient with juvenile chronic arthritis
Authors: Kümmerle‐Deschner J , Dannecker G
Published: January 2008

Sulphasalazine is an effective drug for the treatment of rheumatoid arthritis in adults. In paediatric patients, the drug has been used to treat inflammatory bowel disease and is currently under investigation for the treatment of juvenile chronic arthritis. Although sulphasalazine has a rather low incidence of serious side effects, one of the most common is skin rash, thought to be an allergic reaction. In adults, sulphasalazine desensitization programmes have proven to be effective for the treatment of this side effect. We present the case of a 7‐year‐old boy suffering from HLA‐B 27 positive juvenile chronic arthritis. After initiation of treatment with sulphasalazine he developed an allergic skin rash, but tolerated the drug well after completion of a desensitization programme. To our knowledge, this is the first report of a paediatric patient with juvenile chronic arthritis successfully desensitized with sulphasalazine.Desensitization, juvenile chronic arthritis, sulphasalazine

J Kiimmerle‐Deschner, Universitdtskinderklinik Tubingen, Rumelinstr. 19‐23, 72076 Tubingen, Germany
Early re‐feeding in the management of acute diarrhoea in infants of 0‐1 year of age
Authors: Nanulescu M , Condor M , Popa M , Mureşan M , Pan$tLa P , Ionac S , Popescu L , Sârb S , Suciu D , Corduneanu D , Rusu C
Published: January 2008

We compared early versus late re‐feeding in the management of acute diarrhoea in the first year of life. In the study group (73 patients) breast feeding was resumed or early re‐feeding was performed in non‐breast‐fed infants, so that the feeding regimen used prior to the onset of the disease was reached within 2‐3 days. In the control group (49 patients) late re‐feeding was performed so that the infants returned to their original feeding pattern after 4‐6 days. There were no significant differences between the two groups in the number of stools and stool output per day, or in the duration of the disease. No weight gain or loss during the diet was noted more frequently in the late re‐feeding group (67.2% versus 23.4%). This study confirms the favourable effect on body weight of early re‐feeding in the management of acute diarrhoea.

Acute diarrhoea in infants, early re‐feeding
Breast feeding and seasonal determinants of child growth in weight in East Bhutan
Authors: Bøhler E , Aalen O , Bergstram S , Halvorsen S
Published: January 2008

In a prospective study of 113 children in rural Bhutan, morbidity, nutritional status and feeding practices were recorded monthly over a period of 32 months. This information was related to seasonal variations in rainfall. Diarrhoea had a negative impact on growth, as measured in monthly intervals, during the second and third years of life, reducing daily weight gain by 4.42.0 g (p < 0.0001). This impact was largest during the monsoon season. For respiratory tract infections the value was 2.61.7 g (p < 0.01). Growth in weight was lowest during the monsoon period (p < 0.0001). Continued breast feeding was associated with an odds ratio for diarrhoea of 0.51 (95% CI 0.34‐0.78), and for respiratory tract infections of 0.63 (95% CI 0.40, 0.99). Growth in weight was less reduced during the monsoon season for children who were breast fed (2.5 1.7 g/day) than for those not breast fed (7.53.5 g/day) {p < 0.01). We conclude that breast feeding is of particular importance throughout the warm and rainy season. ? Breast feeding, diarrhoea, growth, respiratory tract infections, seasonal variation

E Bohler, Department of International Health, Box 1130 Blindern, 0318 Oslo, Norway
Volumetric bone mineral density — a potential role in paediatrics
Authors: Cowell CT , Lu PW , Lloyd‐Jones SA , Briody JN , Allen JR , Humphries IRJ , Reed E , Knight J , Howman‐Giles R , Gaskin K
Published: January 2008

The use of areal bone mineral density (aBMD) in paediatric populations has aroused some concern, as it fails to take the age‐related increase in bone thickness into account. We have developed a measure of true bone density, volumetric bone mineral density (vBMD), which is independent of age and height. In order to examine the relationship between growth parameters, aBMD and vBMD, we studied patients with phenylketonuria (PKU, n = 40), chronic renal failure (CRF, n = 27) and chronic asthma (n = 19). aBMD of the femoral neck and the mid‐femoral shaft was measured using dual energy X‐ray absorptiometry (DXA), vBMD was calculated on the basis of values of bone mineral content and bone dimension provided by DXA, with the assumption that both sites are cylinders. aBMD and vBMD were then compared with the normal reference, expressed as a standard deviation score (SDS). aBMD and vBMD were normal in the femoral neck region of the PKU group, but aBMD, either standardized for age or for height, was low in the femoral shaft region (p < 0.01). In the CRF group, profound growth retardation was seen (mean height SDS, −3.2) and aBMD and vBMD were both low in the femoral shaft region but not in the femoral neck. In the asthma group, aBMD for age was low at both sites, but vBMD did not differ from that seen in normal individuals. We conclude that the true vBMD provides a different interpretation of bone density compared with aBMD and requires further evaluation in paediatrics because of its age and height independence.