bluuebunny/crossref_metadata_2025 huggingface dataset:
Aetiology and outcome of pneumonia in human immunodeficiency virus‐infected children hospitalized in South Africa
Authors: Zar HJ , Hanslo D , Tannenbaum E , Klein M , Argent A , Eley B , Burgess J , Magnus K , Bateman ED
Published: August 2010

To determine the aetiology and outcome of pneumonia in human immunodeficiency virus (HIV)‐infected children, we prospectively investigated 250 children hospitalized with pneumonia who were known or clinically suspected to be HIV‐positive, or who required intensive care support in Cape Town, South Africa. Blood culture, induced sputum or bronchoalveolar lavage nasopharyngeal aspirate and gastric lavage were performed. Of the total, 151 children (60.4%) were HIV‐infected. Pneumocystis carinii pneumonia (PCP), occurring in 19 (7.6%) children (15 HIV‐positive), was the AIDS‐defining infection in 20.3%. The incidence and type of bacteraemia (14.3%) were similar in HIV‐positive and HIV‐negative patients; S. pneumoniae (5%) and S. aureus (2%) were the predominant isolates. Sputum or BAL cultures yielded bacteria in 145 of 243 (60%) specimens; viruses were cultured in 37 (15.2%). Bacterial prevalence (including M. tuberculosis in 8%) and anti‐microbial resistance did not differ by HIV status except for S. aureus which was more common in HIV‐infected children. Thirty‐one (20%) HIV‐positive and 8 (8%) HIV‐negative children died [RR 1.16 (95% CI 1.05–1.28), p= 0.008]; using multiple logistic regression, PCP was the only risk factor for mortality (p= 0.03).

Conclusion: In South Africa, PCP is an important AIDS‐defining infection in children; bacterial pathogens occur commonly and with a similar prevalence in HIV‐positive and HIV‐negative children hospitalized for pneumonia. HIV‐infected children with pneumonia have a worse outcome than HIV‐negative patients.
Plasma thrombomodulin levels in children with atopic dermatitis
Authors: Yoshijima S , Kojima T , Sasai M , Hattori K , Taniuchi S , Kobayashi Y
Published: August 2010

Plasma thrombomodulin (TM) levels were measured in 68 patients with atopic dermatitis (AD) and 35 controls. Plasma TM levels in patients with AD were significantly higher than those of controls (p < 0.01). A significant correlation was observed between plasma TM levels and skin scores of AD or peripheral eosinophil counts (p < 0.01). There was also a positive correlation between plasma TM and vascular cell adhesion molecule‐1 levels (p < 0.05).

Conclusion: These results suggest that plasma TM levels may reflect a severity of AD and/or endothelial cell activation induced by an allergic inflammation.
Short‐term effects of severe hypoglycaemia in children and adolescents with type 1 diabetes. A cost‐of‐illness study
Authors: Nordfeldt S , Jonsson D
Published: August 2010

The aim of this study was to describe costs and other short‐term effects of severe hypoglycaemia in children and adolescents with type 1 diabetes. The study comprised a geographic population of 129 patients <19y of age with families prospectively registering detailed data after self‐reported severe hypoglycaemia. In the period Jan.‐Dec. 1998, 16 events were reported with unconsciousness and 95 events without unconsciousness but needing the assistance of another person. Of all events, 20–30% had effects requiring the assistance of people other than parents, school absence, parents' absence from work, extra transport and/or telephone calls. Patient (family) activities were cancelled after 10% (5%) of events. Increased worry for parents was reported after 8% and poor sleep after 7% of events. Hospital visits took place at 5% and hospitalizations at 3% of all events. Patients with severe hypoglycaemia indicated lower global quality of life (p= 0.0114). The average socio‐economic burden for events of severe hypoglycaemia was estimated at EURO 17 400 yearly per 100 type 1 diabetes patients. Average cost was estimated at EURO 239 per event of severe hypoglycaemia with unconsciousness or EURO 478 yearly per patient with unconsciousness, and EURO 63 per event of severe hypoglycaemia without unconsciousness but needing assistance from another person or EURO 307 yearly per patient in this category. These are conservative estimates and do not include unpaid time and other intangibles, possible road traffic accidents, disabling or premature deaths.

Conclusions: The results suggest the potential for socio‐economic savings and increased quality of life for patients and families from severe hypoglycaemia prevention programs.
Generalization of back education principles by elementary school children: evaluation with a practical test and a candid camera observation
Authors: Cardon G , De Bourdeaudhuij I , De Clercq D
Published: August 2010

The efficacy of back education in elementary school children was shown using a practical test. Similar results in a candid camera evaluation were questioned. The purposes of this study were (i) to explore the relationship between the results of a practical test and the results of a candid camera procedure when evaluating back education principles, and (ii) to investigate whether in a candid camera procedure scores are still better in pupils who followed a back education programme than in controls. A candid camera evaluation followed by a practical test was performed in 71 pupils who had participated in a back education programme and 60 controls. Correlations between the two evaluation methods were significant but weak for 5 of the 9 test items in the intervention group (Rs 0.26–0.46) and for 7 test items in the control group (Rs 0.38–0.58). The difference in sum scores between the evaluation methods was significantly higher in the intervention group than in the control group (p < 0.001). The intervention group scored higher than the control group for 8 practical test items and 7 candid evaluation items.

Conclusion: The study results question the use of a practical test for the individual evaluation of back education principles but show the usefulness of a practical test to study programme efficacy. As some principles seem to have become a habit, while for the implementation of others the pupils need external stimuli, the effects of more specific guidelines for parents and teachers to generalize back education principles require further study.
Patent ductus venosus does not lead to alimentary galactosaemia in preterm infants
Authors: Fugelseth D , Guthenberg C , Hagenfeldt L , Liestøl K , Hallerud M , Lindemann R
Published: August 2010

The aim of this study was to investigate if an open ductus venosus representing a portal‐caval shunt can lead to transient “alimentary galactosaemia” in preterm infants fed human breast milk. Twenty‐six preterm infants (28–34 wk of gestational age) with open ductus venosus were included. Capillary blood samples for measurement of galactose and glucose were collected before, 30 and 50 min after a meal with breast milk (range 12–23 mL/kg). Ultrasound studies of the blood flow in the ductus venosus, truncus coeliacus, superior mesenteric artery and left hepatic vein were performed before and 30 min after the meal. There was a significant rise in blood glucose after 30 and 50 min, indicating a sufficient lactose load. Galactose, however, was either not detectable or was just above the detectable limit (0.1–0.4 mmol/L), with no changes after the meal. An increased flow velocity was found in the ductus venosus and superior mesenteric artery after 30 min (p≫ 0.001) indicating increased entero‐hepatic and portal‐caval shunting.

Conclusion: A patent ductus venosus does not lead to a significant hypergalactosaemia in preterm infants fed human breast milk. Thus, in respect to breast‐milk feeding, this is regarded safe in healthy preterm infants even with an open ductus venosus. The increased portal‐caval shunting may, however, influence the hepatic metabolism of other enterally absorbed substances.
Linguistic skills at 6½ years of age in children who required neonatal intensive care in 1986–1989
Authors: Jennische M , Sedin G
Published: August 2010

Linguistic skills at 6½y of age, corrected for gestational age at birth, were examined in a cohort of 230 children who had required neonatal intensive care (NIC) in 1986–89, and in 71 fullterm neonatally healthy control children (C) matched to the NIC children born at <32 gestational weeks. Ten linguistic areas were assessed. The 10th percentile score of the controls was identified in each linguistic area and used for comparisons. In 77.5% of the controls and 63.5% of the NIC children, no score was lower than the 10th percentile score of the controls. Scores lower than the 10th percentile score were more common in NIC children born at term or at 23–31 wk, and within this group of children those born at 23–27 wk, than in controls.

Conclusion: In preterm children of <32 wk the results in the linguistic areas of imitation of articulatory positions, comprehension of logical grammatical constructions, phonemes and word fluency differed from those of the matched controls, and in NIC children born at 32 weeks the results for imitation of articulatory positions, articulatory patterns and sentences, auditory discrimination and word fluency were poorer than those of the controls.
Utilization of healthcare by very‐low‐birthweight infants during their first year of life
Authors: Jackson K , Schollin J , Bodin L , Ternestedt B‐M
Published: August 2010

New knowledge in perinatal medicine has resulted in increased survival of very‐low‐birthweight (VLBW) infants. After leaving hospital, the child is seen at regular medical check‐ups, but there is often a persistent worry about the child which affects the family as a whole. This can lead to an increased utilization of healthcare. Our objective was therefore to describe the utilization of healthcare by VLBW infants during their first year of life and its relation to high‐risk diagnoses in the neonatal period. The study group comprised 36 infants born at gestational ages of ≫31 wk and with a birthweight of ≫1500 g, and was compared with a control group of 36 full‐term infants.

Utilization of healthcare by the VLBW infants was higher than that by the control group in paediatric and ophthalmic outpatient clinics. The total number of contacts with healthcare was on average 38.7 versus 17.4. High‐risk diagnoses in the neonatal period did not correlate with utilization of care, except for visits to the paediatric outpatient clinic, especially planned visits. Further studies focusing on how to support these families after leaving hospital are therefore needed.
Associations of age and gender with activity and sleep
Authors: Aronen ET , Paavonen EJ , Soininen M , Fjällberg M
Published: August 2010

Associations between age/gender and activity/sleep (measured by actigraphs) in 66 healthy children aged 5–12 y were studied. With increasing age, daytime motor activity and total sleep time decreased and activity pattern changed. No gender differences were found.

It was concluded that in this age group there is an age‐dependent change in the amount and pattern of motor activity and sleep due to developmental and/or environmental factors.
Evaluation of serum lipoprotein(a) levels in Greek schoolchildren
Authors: Schulpis KH , Karikas GA , Gavrili S , Georgala S
Published: August 2010

This study aimed to provide associations of age and gender with serum lipoprotein(a) [Lp(a)] levels and percentile distribution data for Greek children. In total, 3298 children (1590M, 1708F, aged 6–14 y) participated in the study. Lp(a) levels were evaluated with an immunosorbent assay. Mean Lp(a) levels were 153–157 mg l‐1 for boys and 146–151 mg l‐1 for girls, and median levels 133–139 mg l1 for boys and 100–108 mg l‐1 for girls.

Conclusion: The Lp(a) levels in these children were the lower ever reported. These results suggest that the young Greek population is not at high risk of developing coronary heart disease as a result of high Lp(a) levels.
Effect of publication of the “Practice Parameter for the Management of Hyperbilirubinemia” on treatment of neonatal jaundice
Authors: Seidman DS , Paz I , Armon Y , Ergaz Z , Stevenson DK , Gale R
Published: August 2010

The aim of this study was to evaluate the change in the treatment of neonatal jaundice following introduction of the “American Academy of Pediatrics’ Practice Parameter for the management of hyperbilirubinemia in the healthy term newborn'. In a historical control observation cohort study, we examined the rate of phototherapy and exchange transfusions among full‐term (≫37wk gestation) and near‐term (gestational age between 35 and 37 wk and birthweight >2000g) infants in two community hospitals. The study included all consecutive infants born during two 15‐mo study periods immediately before and after the introduction of the new guidelines. Data were prospectively recorded in a computerized database. The rate of phototherapy significantly decreased in the second study period from 7.9% (514/6499) to 2.9% (251/8650) (p < 0.0001) among full‐term infants, and from 20.9% (102/489) to 9.4% (47/502) (p < 0.0001) in near‐term infants. The use of exchange transfusion was significantly higher (p < 0.001) in the first compared to the second period: 0.2% (15/6499) vs 0.03% (3/8650). A significant decrease was found when the data from each hospital were analyzed separately.

Conclusion: A significant decrease in the use of phototherapy and exchange transfusion occurred after the publication of the new practice parameters. This trend was observed for both term and preterm newborns, although the new guidelines were not intended for infants born before term.
Early administration of the second dose of surfactant (beractant) in the treatment of severe hyaline membrane disease
Authors: Figueras‐Aloy J , Quero J , Carbonell‐Estrany X , Ginovart G , Pérez‐Rodríguez J , Raspall F , Miguélez JM Rodríguez , Salvía MD
Published: August 2010

The aim of this study was to demonstrate that administration of the second dose of beractant 2 h after the first one is more effective than 6 h after the initial dose. The inclusion criteria for the recruitment of newborn infants were: age ≪8 h, birthweight 600–2000 g, gestational age 23–36 wk, need for mechanical ventilation with inspiratory oxygen fraction (F io2) ≫0.4 and mean airway pressure (MAP) ≪7cmH2O to obtain arterial oxygen tension (P ao2) values between 70 and 80mmHg, and thoracic X‐ray compatible with hyaline membrane disease (HMD). Newborns with major congenital malformations, hydrops fetalis or severe pulmonary hypoplasia, or being treated with high‐frequency oscillatory ventilation were excluded. In total, 57 premature newborns were studied, 20 of them below 1000 g, who received 100mgkg‐1 of beractant in 2 aliquots and showed an inadequate response, i.e. after 2 h of the first dose the newborn still needed a F io2≫ 0.4 and a MAP ≪ 7 cmH2O to achieve a P ao2 > 70 mmHg. The second dose was randomly administered 2 or 6 h from the first one.

Conclusion: The 2 study groups were comparable except for a higher need of dopamine and seroalbumin in 2‐h group. Evolution and complications were similar. Twelve hours after the first dose, the percentage improvement in the arteriolar/alveolar ratio (a/ADO2) in the 2‐h group was similar to that in the 6‐h group. However, in newborns below 1000 g, 12 h after the first dose the a/ADO2 percentage improvement in the 2‐h group was greater than in 6‐h group (median of 103.6% vs 16.3%; p= 0.035). In premature infants below 1000 g, it seems reasonable to advance the second dose of beractant if needed.
Patent ductus arteriosus and cystic periventricular leucomalacia in preterm infants
Authors: Pladys P , Beuchée A , Wodey E , Tréguier C , Lassel L , Bétrémieux P
Published: August 2010

Aim: To test the association between early disturbances in hemodynamics induced by left‐to‐right shunting through the duct and cystic periventricular leucomalacia. Patients: Forty‐six preterm infants (27–32 wk) admitted to the neonatal intensive care unit with risk criteria. Methods: Patent ductus arteriosus was evaluated on days 1 and 4, and was significant (sPDA) in cases of absent or reversed end diastolic flow in the subductal aorta. Resistance index was measured in the anterior cerebral artery and in the subductal aorta. Main outcome: Diagnosis of cystic periventricular leucomalacia between day 10 and day 50. Results: The 12 infants who developed cystic periventricular leucomalacia were compared with those who did not. On day 1, sPDA was more frequent (64% vs 26%; p= 0.03) in the cystic periventricular leucomalacia group, left ventricular output was higher (median = 341 vs 279mlkg‐1.min‐1; p= 0.005), and rescue surfactant was more frequently used (83% vs 47%; p= 0.03). This latter association was confirmed by multivariate analysis. Resistance index in the anterior cerebral artery was increased in cases of significant patent ductus arteriosus (p < 0.01) and was correlated with resistance index in the subductal aorta.

Conclusion: On day 1 in this selected population, sPDA has an effect on blood flow velocity waveform in cerebral arteries and is associated with an increase in the emergence of cystic periventricular leucomalacia. This association could be casual rather than causal.
Malassezia pachydermatis fungaemia in a neonatal intensive care unit
Authors: Chryssanthou E , Broberger U , Petrini B
Published: August 2010

Malassezia pachydermatis, a non‐obligatory lipophilic yeast, has occasionally been implicated in nosocomial fungaemias. This study investigated a cluster of eight cases of M. pachydermatis infection and colonization in a neonatal intensive care unit over a 6 mo period. All patients were preterm with very low birthweight and suffered from various underlying diseases. Prolonged use of indwelling catheters and parenteral lipid formulations were important predisposing factors for their infection. All M. pachydermatis strains were susceptible to amphotericin B, fluconazole and itraconazole but resistant against flucytosine.

Conclusion: Molecular typing by random amplification of polymorphic DNA showed distinct banding profiles for each blood isolate. Since no epidemiological association among the strains could be shown, the reason for this cluster of nosocomial fungaemias remains unclear.
Predictors of recurrent abdominal pain among 9 to 15‐year‐old urban school‐children in Malaysia
Authors: Boey CCM , Goh K‐L
Published: August 2010

A cross‐sectional survey of school‐children aged from 9 to 15 y was performed in the city of Petaling Jaya to look for predictors of recurrent abdominal pain. A sample of 1488 children was randomly chosen, of whom 143 (9.6%) had recurrent abdominal pain according to Apley's criteria.

Conclusion: The results of the study show that recurrent abdominal pain was associated with a number of demographic variables, a tendency to have other complaints and a family history of chronic abdominal complaints.
Meconium aspiration syndrome: a role for phospholipase A2 in the pathogenesis?
Authors: Kääpä P
Published: August 2010

The pathophysiology of neonatal meconium aspiration syndrome (MAS), often resulting in severe respiratory failure, is complex and still largely unclear. Factors involved in the propagation of acute lung injury after perinatal aspiration of meconium include obstruction of the airways, ventilation/perfusion mismatch, increase of the pulmonary vascular resistance and a rapidly developing parenchymal and alveolar inflammatory reaction with associated surfactant dysfunction.

Conclusion: Although the early pulmonary inflammatory response is believed to play a central pathogenetic role in the meconium‐induced acute lung damage, its initiating mechanisms are still poorly defined. However, increasing evidence indicates a direct toxic effect of meconium.
Inguinal hernias in premature babies: wait or operate?
Authors: Misra D
Published: August 2010

There are several contentious issues in the management of inguinal hernias in premature neonates. They include the timing of surgery, the management of incarceration, the role of routine contralateral groin exploration and the type of anaesthesia. In this article we re‐emphasize the importance of delaying surgery until the baby is ready for discharge from the neonatal unit. Regular examinations and manual reduction of these hernias should be performed in order to detect incarcerations early.

Conclusion: With this approach, it may be possible to minimize the morbidity resulting from incarceration, and at the same time avoid the respiratory and testicular complications resulting from an early surgical/anaesthetic intervention.
A randomized controlled clinical trial of zinc, vitamin A or both in undernourished children with persistent diarrhea in Bangladesh
Authors: Khatun UHF , Malek MA , Black RE , Sarkar NR , Wahed MA , Fuchs G , Roy SK
Published: August 2010

In a double‐blind randomized controlled clinical trial, moderately malnourished Bangladeshi children (61–75% of the median weight/age) were studied for the effect of zinc and/or vitamin A supplementation on the clinical outcome of persistent diarrhea. Children 6 mo to 2 y of age with diarrhea for more than 14 d were randomly allocated into 4 groups of 24 receiving a multivitamin syrup and (i) zinc (20 mg elemental), (ii) vitamin A, (iii) both zinc and vitamin A, or (iv) neither, in 2 doses daily for 7 d. Clinical data on recovery and on stool output, consistency and frequency were recorded for 7 d, and weight change from day 1 to day 7 was assessed. The baseline characteristics of the four study groups were comparable. The mean daily stool outputs from days 2 to 7 of therapy were significantly less in the zinc and zinc plus vitamin A groups, but not in the vitamin A group, in comparison with the control group. In children receiving zinc, the cumulative stool weight in the 7 d was 39% less than in the control group (p < 0.001) and 32% less than in the vitamin A group (p= 0.006). The cumulative stool weight in the zinc plus vitamin A group was 24% less than in the control group (p <0.001), but the 14% lower output than in the vitamin A group was not statistically different The change in body weight over the 7d study period was significantly different between the group receiving zinc and the control group (+111 g vs –90 g, p = 0.045). The rate of clinical recovery of children within 7 d was significantly greater in the zinc group (88%) compared with the control group (46%, p= 0.002) or vitamin A group (50%, p= 0 005), but not statistically different from the zinc plus vitamin A group (67%, p= 0.086).

Conclusion: The results indicate that zinc, but not vitamin A, supplementation in persistent diarrhea reduces stool output, prevents weight loss and promotes earlier recovery.
Growth tracks in early childhood
Authors: Hermanussen M , Lange S , Grasedyck L
Published: August 2010

Aim: Child growth is modulated by numerous factors and, particularly in infancy and early childhood, often tends to follow apparently irregular patterns, with many centiles crossed before the later growth channels are reached. The aim of this study was to visualize the diversity of individual growth. Design: The study investigated 333 girls and 329 boys without chronic illnesses from four paediatric practices in Kiel, Germany. The children were measured on natural, i.e., on various occasions, when they were presented to their doctors for preventive care examinations and for minor illnesses, at the age of 0.25 (range ± 0.08) y, 0.5 (range ± 0.16) y, 0.75 (range ± 0.16) y, 1.0 (range ± 0.25) y, and at the ages of 1.5, 2, 3, 4 and 5 (range ± 0.25) y. Each individual growth curve was converted into a series of height SDS (standard deviation scores) using one of the most reputable longitudinal German growth studies as background reference. Height SDS was then converted into residual height SDS (differences between height SDS of each measurement and average personal height SDS of the respective child). Cluster analysis was used to identify groups of children (clusters) with similarities in residual height SDS patterns (growth tracks). The clusters contained a minimum of at least 10 children. Single children or small sets of individuals below the minimum number were rejected from further analysis. Results: In males, 10 growth tracks were identified, each consisting of 11 to 52 boys. Growth in 111 boys was so heterogeneous that they could not be assigned to growth tracks. In females, 11 growth tracks were identified, each consisting of 12 to 48 girls; 112 girls could not be assigned. Approximately 7% of boys and 15% of girls showed evidence of a mild intermittent growth spurt at the end of infancy. Some growth tracks were almost horizontal, or showed declining residual height SDS up to the age of 3 and 4 y, with no evidence of growth spurts during early childhood. Others showed sharply declining growth in early infancy, or irregular patterns. Similar results were obtained when using cross‐sectional standards as background reference.

Conclusion: Cluster analysis provides evidence that the substantial diversity in infant and early child growth is limited to a small number of narrow but characteristic tracks of yet unknown biological significance.
Phospholipase A2 is present in meconium and inhibits the activity of pulmonary surfactant: an in vitro study
Authors: Schrama AJJ , de Beaufort AJ , Sukul YRM , Jansen SM , Poorthuis BJHM , Berger HM
Published: August 2010

Atelectasis, a major contributor to pulmonary dysfunction in meconium aspiration syndrome (MAS), is produced by bronchiolar obstruction and surfactant inactivation. It has been shown that substances in meconium, e.g. fatty acids, inhibit surfactant activity. However, the role of the enzyme phospholipase A2 (PLA2), which hydrolyses surfactant in adult respiratory distress syndrome (ARDS), has not yet been studied. Our objective was to investigate whether PLA2 is present in meconium and inhibits pulmonary surfactant activity in vitro. Therefore, the presence of PLA2 activity in meconium, collected from 10 newborns, was measured by the formation of lysophosphatidylcholine after incubation of meconium with radioactively labelled dipalmitoylphosphati‐dylcholine. Meconium was fractionated by Sephadex G‐100 column chromatography and the fractions were assayed for PLA2 activity. Also, their effect on the surface tension of surfactant (Curosurf) was measured using a pulsating bubble surfactometer (PBS). PLA2 activity was present in all meconium samples. Addition of meconium to surfactant significantly increased surface tension (mean ± SD: 17 ± 1.6 mN/m to 24.3 ± 6.7 mN/m, p= 0.0001) and only the addition of the PLA2 containing fraction from meconium to surfactant also significantly increased surface tension (mean 1.7 ± 1.6mN/m to 19.0 ± 3.58 mN/m, p < 0.0001).

Conclusion: PLA2 is present in meconium and inhibits the activity of pulmonary surfactant in vitro. Therefore, PLA2 in meconium may contribute to surfactant inactivation and alveolar ateectasis in MAS.
Parental reported apnoea, admissions to hospital and sudden infant death syndrome
Authors: Mitchell EA , Thompson JMD
Published: August 2010

Three studies were undertaken: (i) a nation‐wide case‐control study for sudden infant death syndrome (SIDS), with 393 cases and 1592 controls, examined the association between parental reported apnoea and SIDS; (ii) a case‐cohort study, with 84 cases of parental reported apnoea and 1502 controls, aimed to identify risk factors for apnoea; and (ii) national hospital admission data for ALTE and national SIDS mortality data were compared for the years 1986 to 1994. Parental reported apnoea was associated with a significant increased risk of SIDS [adjusted odds ratio (OR) 1.86; 95% confidence interval (CI) 1.12, 3.09]. The population attributable risk was 8%. There was a significant increased risk for parental reported apnoea in infants who did not die after adjustment for potential confounders with maternal smokers, short gestation and admission to the neonatal unit. There was no association with prone sleeping position, co‐sleeping and bottle feeding. The mean annual admission rate for ALTE was 9.4/1000 live births. This did not change significantly over the study period (1986–1994). In contrast, the SIDS mortality rate decreased from over 4/ 1000 to 2.1/1000. Admission rates were higher for Maori infants and boys.

Conclusion: It may be concluded that the relationship between parental reported apnoea and SIDS is tenuous.
Maternal employment and the initiation of breastfeeding
Authors: Noble S ,   The ALSPAC Study Team
Published: August 2010

This study examines whether planning to be employed postpartum has an effect on initiation of breastfeeding. Data were collected from questionnaires completed by mothers who were subjects in the prospective, population‐based, Avon Longitudinal Study of Pregnancy and Childhood. The mothers of 10 530 full‐term singleton infants gave information during pregnancy on their postpartum employment plans and their initial infant feeding methods. Information was also given by 7642 of these mothers on the timing of their postpartum employment plans. Adjusted logistic regression was performed to identify associations between (a) “any” plans to work postpartum and the initiation of breastfeeding, and (b) the timing of the commencement of work postpartum, and the initiation of breastfeeding. A total of 8316 (79%) of the women initiated breastfeeding. The decision to breastfeed was not associated with “any” plans to work postpartum. However, women who planned to commence work prior to 6 wk postpartum were significantly less likely to initiate breastfeeding compared with those not intending to work postpartum. Older, more highly educated women, women who had or were planning to attend childbirth classes, women who were breastfed as infants, women who did not smoke and women who were giving birth to their first child were significantly more likely to initiate breastfeeding.

Conclusion: Planning to return to employment prior to 6 wk postpartum reduces the likelihood of initiating breastfeeding. As increasing numbers of mothers are returning to work shortly after the birth of their child, this finding could have implications for maintaining the current level of breastfeeding.
Sociodemographic differences in patterns of sedentary and physically active behavior in older children and adolescents
Authors: Kristjansdottir G , Vilhjalmsson R
Published: August 2010

Numerous studies have found that involvement in moderate‐intensity and strenuous activity has positive effects on health. This study considered the prevalence of different aspects of physical activity and sedentary behavior in 11–16‐y‐olds based on a representative national survey of 3270 Icelandic primary schoolchildren (91% response rate). All‐day sedentary behavior was extremely rare (<1%), and the vast majority (91%) were physically active (≫3 times per week) during school or leisure time, thanks largely to school physical education. Only 39% were physically active (≫3 times per week) during leisure time, and only 29% engaged in regular (≫3 times per week) leisure time strenuous exercise. Girls were more sedentary, less leisure time physically active, and less involved in leisure time strenuous exercise. Sedentary behavior increased and physically active behavior decreased with age, especially after early adolescence. However, there were no age differences in strenuous leisure time exercise. Upper‐class students were less sedentary and more physically active during leisure time than working‐class students. Finally, rural students were more sedentary during leisure time, and less physically active than students from urban areas. An interaction was found between age and residence when predicting leisure time physical activity, indicating that the inverse age‐activity relationship in urban areas is partly reversed in rural areas.

Conclusion: Compulsory school physical education frequently failed to translate into voluntary physical involvement. Sociodemographic differences in physical activity were greater during leisure time, than during school and leisure time combined.
Prevalence of iron deficiency in 12‐mo‐old infants from 11 European areas and influence of dietary factors on iron status (Euro‐Growth study)
Authors: Male C , Persson LÅ , Freeman V , Guerra A , van't Hof MA
Published: August 2010

A prospective longitudinal cohort study was performed to assess the prevalence of iron deficiency in European infants at 12 mo of age, and to study the influence of socio‐economic status, dietary factors, growth and morbidity on iron status. The cohort consisted of 488 normal term infants from primary healthcare centres in 11 European areas. Assessed were socio‐economic variables, dietary intake, anthropometry and morbidity at regular intervals from birth to 12 mo, and haemoglobin, serum ferritin, mean corpuscular volume, transferrin saturation and serum transferrin receptor concentrations at age 12 mo. The prevalence of anaemia was 9.4%, of iron deficiency 7.2%, and of iron deficiency anaemia 2.3%. More than 40% of anaemia was associated with normal iron status and associated with an increased frequency of recent infections. Iron deficiency anaemia was significantly more frequent with low (5.1%) than high socio‐economic status (0%). Dietary factors accounted for most of this variation in multiple regression analysis. Early introduction of cows' milk was the strongest negative determinant of iron status. Feeding of iron‐fortified formula was the main factor positively influencing iron status. Other dietary factors, including breastfeeding, did not play a significant role as determinants of iron status at age 12 mo.

Conclusion. Iron deficiency anaemia is present in 2.3% of 12‐mo‐old European infants. The prevalence of iron deficiency anaemia varies strongly with socio‐economic status. Avoidance of cows' milk feeding during the first year of life is the key measure in the prevention of iron deficiency.
Fluid resuscitation in infantile hypertrophic pyloric stenosis
Authors: Miozzari HH , Tönz M , von Vigier RO , Bianchetti MG
Published: August 2010

The purpose of this analysis was to investigate biochemical disturbances at presentation and initial fluid resuscitation before surgery in infantile pyloric stenosis. The charts of 139 consecutive infants (113 boys and 26 girls) between 7d and 20 wk of age with hypertrophic pyloric stenosis were reviewed. The infants were treated at the Department of Pediatric Surgery, University of Bern, Switzerland, in the period between 1987 and 1997. A trend towards hypokalemia (13 of the 139 patients), hypochloraemia (39 patients) and especially metabolic alkalosis (98 patients) was frequently noted on admission. In 84 patients, data on fluid management and on circulating sodium, potassium, chloride and the acid‐base balance immediately before surgery were also available. In these patients a significant correlation was found between the parenteral chloride dose given for fluid repair (y= 0.310 x; rs= 0.54; p > 0.001) and the changes in plasma bicarbonate. The equation indicates that a chloride dose of 10mmol/kg body weight is required to reduce plasma bicarbonate on average by 3 mmol/l.

Conclusion: Since assessment of the fluid volume stated by physical examination and history is inaccurate in infants with vomiting, the severity of metabolic alkalosis helps to define the amount of fluid required for repair.
Effects of growth hormone treatment on the leptin system and body composition in obese prepubertal boys
Authors: Elimam A , Norgren S , Marcus C
Published: August 2010

Leptin correlates with measures of body fat stores. Growth hormone (GH) treatment may affect leptin levels either directly or indirectly by influencing body composition and circulating insulin level. Here, the effects of GH treatment on the leptin axis and body composition of six severely obese, but otherwise healthy, prepubertal boys were studied. Fasting serum leptin was significantly reduced after only 3 wk of GH treatment. Body fat percentage, but not BMI, decreased significantly (p < 0.05) after 3 mo. The serum leptin concentration per unit fat mass decreased significantly during GH treatment (p < 0.05), suggesting that such treatment might have a direct effect on serum leptin independently of the effects on body composition. Leptin RNA expression in abdominal subcutaneous tissue was not significantly changed by treatment.

Conclusions: The data indicate that GH has an early downregulatory effect on the circulating leptin level independently of the concomitant changes in body composition. Whether GH affects leptin production or metabolism needs further study.
Premature cessation of breastfeeding in infants: development and evaluation of a predictive model in two Argentinian cohorts: the CLACYD study*, 1993–1999
Authors: Berra S , Rajmil L , Passamonte R , Fernandez E , Sabulsky J
Published: August 2010

The objective of this study was to develop a model to predict premature cessation of breastfeeding of newborns, in order to detect at‐risk groups that would benefit from special assistance programmes. The model was constructed using 700 children with a birthweight of 2000 g or more, in 2 representative cohorts in 1993 and 1995 (CLACYD I sample) in Córdoba, Argentina. Data were analysed from 632 of the cases. Mothers were selected during hospital admittance for childbirth and interviewed in their homes at 1 mo and 6 mo. To evaluate the model, an additional sample with similar characteristics was drawn during 1998 (CLACYD II sample). A questionnaire was administered to 347 mothers during the first 24–48 h after birth and a follow‐up was completed at 6 mo, with weaning information on 291 cases. Premature cessation of breastfeeding was considered when it occurred prior to 6 mo. A logistic regression model was fitted to predict premature end of breastfeeding, and was applied to the CLACYD II sample. The calibration (Hosmer‐Lemeshow C statistic) and the discrimination [area under the receiver operating characteristics (ROC) curve] of the model were evaluated. The predictive factors of premature end of breastfeeding were: mother breastfed for less than 6 mo [odds ratio (OR) = 1.84,95% confidence interval (CI) 1.26–2.70], breastfeeding of previous child for less than 6 mo (OR = 4.01, 95% CI 2.58–6.20), the condition of the firstborn child (OR = 2.75, 95% CI 1.79–4.21), the first mother‐child contact occurring after 90min of life (OR =1.88; 95% CI 1.22–2.91) and having an unplanned pregnancy (OR = 1.50, 95% CI 1.05–2.15). The calibration of the model was acceptable in the CLACYD I sample (p= 0.54), as well as in the CLACYD II sample (p= 0.18). The areas under the ROC curve were 0.72 and 0.68, respectively.

Conclusion: A model has been suggested that provides some insight onto background factors for the premature end of breastfeeding. Although some limitations prevent its general use at a population level, it may be a useful tool in the identification of women with a high probability of early weaning.
Subjective daytime sleepiness and its predictors in Finnish adolescents in an interview study
Authors: Saarenpää‐Heikkilä O , Laippala P , Koivikko M
Published: August 2010

The purpose of this study is to evaluate the predictors of subjective daytime sleepiness (SDS) and its chronicity in adolescents. Two groups of adolescents (107 with SDS and 107 without SDS) from our first questionnaire study were invited to an interview after 3 y. A follow‐up questionnaire had been sent to them one year earlier. The interview included questions about sleep, daytime sleepiness, living habits, physical and mental health, and progress at school. The adolescents were also examined clinically. Interviews were conducted with 66 out of 107 subjects with SDS and 64 out of 107 without SDS (age range 12 to 19 y). In this interview 42 out of the 130 adolescents had SDS. A total of 20 adolescents reported SDS in both questionnaire studies and in the interview (chronic SDS). In a multivariate analysis (logistic regression) sleep disorders, frequent medication and depressive emotions were significantly associated with SDS. Chronic SDS was connected in a bivariate analysis (Pearson's chi‐square) with excessive night waking, difficulty in falling asleep, dreaming, frequent medication, frequent alcohol drinking, and irregular breakfast eating, and in our previous studies also with delayed sleep rhythm.

Conclusion: Sleep disorders and health problems were more common causes of SDS than undesirable living habits. However, alcohol drinking and delayed sleep rhythm were associated with chronic SDS in addition to sleep disorders and medication.
Vitamin D deficiency in Iranian mothers and their neonates: a pilot study
Authors: Bassir M , Laborie S , Lapillonne A , Claris O , Chappuis M‐C , Salle BL
Published: August 2010

We conducted a pilot study to assess the prevalence of hypovitaminosis D among Iranian women and their newborns. Blood samples were taken from 50 mothers (age 16–40 yr) and their neonates at term delivery in the largest Tehran hospital. The results showed that 80% of the women had 25‐hydroxyvitamin D (25‐OHD) concentrations of less than 25 nmol/l. Mean maternal plasma calcium and phosphatase alkaline concentrations were in the normal range. The mean maternal serum immunoreactive parathyroid hormone concentration of women with hypovitaminosis D (i.e., 25‐OHD levels < 25 nmol/l) was above normal range and significantly different from that of women without hypovitaminosis D.

Conclusion: The mean cord serum 25‐OHD concentration was very low (4.94 ± 9.4 nmol/l) and that of infants of mother with hypovitaminosis D were almost undetectable (1.2 ± 1.2 nmol/l).
Non‐Epstein‐Barr virus‐associated T‐cell lymphoma following cardiac transplantation for Barth syndrome
Authors: Ronghe MD , Foot ABM , Martin R , Ashworth M , Steward CG
Published: August 2010

Barth syndrome is a metabolic disease characterized by infantile cardiomyopathy, neutropenia and organic aciduria. We report disease evolution in one of the first affected boys to undergo successful cardiac transplantation.

Conclusion: Although cardiac status stabilized, he developed disabling skeletal myopathy, protracted lymphopenia and‐5 y after transplant‐fatal Epstein Barr (EBV)‐negative T‐cell non‐Hodgkin's lymphoma.
Torticollis revealing as a symptom of acute lymphoblastic leukaemia in a fourteen‐month‐old girl
Authors: Rauch R. , Jüngert J. , Rupprecht T. , Greil J.
Published: August 2010

The differential diagnosis of acquired torticollis in infants and children comprises a large variety of disorders, including inflammation, neurologic disease or trauma.

Conclusion: Spinal cord tumours in patients with ALL are a rarely reported entity and secondary spinal involvement in leukaemia presenting as head tilt is even more uncommon.
Psychological assessments before and after treatment of early puberty in adopted children
Authors: Mul D , Versluis‐den Bieman HJM , Slijper FME , Oostdijk W , Waelkens JJJ , Drop SLS
Published: August 2010

Early puberty is frequently observed in adopted children. This randomized trial treated 30 adopted children with early puberty and short stature with either gonadotropin‐releasing hormone agonist (GnRHa) alone or in combination with growth hormone (GH) for 3 y. Before the start of treatment (T1) in the trial and at discontinuation (T2) the children and their parents underwent a psychological evaluation. At the start of treatment the children did not have increased levels of behavioural or emotional problems as assessed by the Child Behaviour Checklist (CBCL). During treatment the CBCL scores did not increase. Self‐perception of the children appeared to be normal, and after 3 y a significantly higher score for acceptance by peers was observed. At T1, an overestimation of future height was present in 80% of the children and 17% of the parents. Lower family stress was observed at T1 and T2 compared with reference values. Intelligence quotient levels decreased significantly during treatment. The findings are discussed with reference to the reported levels of behavioural and emotional problems in adopted children and the psychosocial effects of precocious puberty.

Conclusion: This psychological evaluation did not reveal any consistent abnormalities in adopted children with early puberty. Treatment with GnRHa with or without GH did not increase emotional and behavioural problems in adopted children, nor was their self‐perception decreased.
Disruption in cytokine and chemokine production by T‐cells in vertically HIV‐1‐infected children
Authors: Resino S , Bellon JM , Gurbindo D , Muñoz‐Fernández MA
Published: August 2010

This study measured cytokine production by mitogen‐stimulated peripheral blood mononuclear cells (PBMCs) from 55 human immunodeficiency virus (HIV)‐infected children born to HIV‐infected mothers, and compared it with vertically exposed but uninfected age‐matched children. A significant defect was observed in Th1 cytokine production [interferon‐γ and interleukin‐2 (IL‐2)] in HIV‐infected children compared with controls, but without a concomitant increase in Th2 cytokines. Indeed, IL‐5 and IL‐10 production was even lower in HIV‐infected children than in controls, with the decrease in IL‐5 being the best predictive marker of immunodeficiency. In addition, an increased release of tumour necrosis factor‐a (TNF‐a) that correlated well with CD4+ levels, and a positive correlation of the TNF‐α/IL‐10 ratio with disease progression was observed. A correlation between AIDS‐free status and higher %CD4+ and %CD8+ T‐lymphocytes and RANTES (regulated on activation, normal T‐cell expressed and secreted) production was also found.

Conclusion: A dysfunctional cytokine production of PBMCs was observed in HIV‐infected children in both Th1 and Th2 cytokines due to quantitative and qualitative defects induced by HIV‐1. An important observation was an increased RANTES production associated with viral isolates of NSI/R5 phenotype and S/L kinetics.
Manganese intake and cholestatic jaundice in neonates receiving parenteral nutrition: a randomized controlled study
Authors: Fok TF , Chui KKM , Cheung R , Ng PC , Cheung KL , Hjelm M
Published: August 2010

Infants requiring parenteral nutrition (n= 244) were randomized to receive either 1 (group 1, n= 121) or 0.0182 μmol/kg/d (group 2, n= 123) of manganese supplementation. The whole‐blood manganese and serum direct bilirubin concentrations of the infants were monitored, as was the development of cholestasis (peak serum direct bilirubin concentration >50 μmol/L). Subgroup analysis was carried out on the data of 78 infants in group 1 and 82 in group 2 who had received manganese supplementation and more than three‐quarters of their total daily fluid as parenteral nutrition for >14 d. Of all the infants randomized, the high manganese group (group 1) showed a trend towards developing higher peak whole‐blood manganese concentration [group 1 versus group 2: median (interquartile range): 606.0 (421.0; 1005.0) vs 566.0 (336.0; 858.0); p= 0.061] and higher peak serum direct bilirubin concentration [37.0 (10.5; 122.5) vs 19.0 (8.0; 112.5); p= 0.153], but the differences between the 2 groups did not reach statistical significance. The 2 groups did not differ in terms of the occurrence of cholestasis during parenteral nutrition (63/121 vs 57/123; p= 0.444). Subgroup analysis of infants who had received more than three‐quarters of their total daily fluid as parenteral nutrition showed, however, that the high manganese group developed significantly higher whole‐blood manganese concentration [743.5 (498.0; 1211.0) vs 587.0 (438.0; 982.0); p= 0.037] and serum direct bilirubin concentration [84.0 (28.0; 170.0) vs 25.5 (9.0; 117.0); p < 0.001]. Although there was no significant difference in the occurrence of cholestasis (58/78 vs 49/82; p= 0.073), more infants in the high manganese group developed a more severe degree of direct hyperbilirubinaemia, with peak serum direct bilirubin >100 μmol/L (32/78 vs 20/82; p= 0.038).

Conclusion: We conclude that the pathogenesis of parenteral nutrition‐related cholestasis is probably multifactorial, and that high manganese intake is a significant contributory factor.