bluuebunny/crossref_metadata_2025 huggingface dataset:
Costs arising from otitis media
Authors: Niemelä M , Uhari M , Möttönen M , Pokka T
Published: August 2010

Otitis media (OM) is one of the most common diseases of childhood, and causes both direct and indirect costs to families and to society. This study calculated the costs arising from OM among 736 day care children whose infections were prospectively monitored for up to 15 mo in 10 day care centres in the city of Oulu. The children in the survey had 1.5 attacks of acute OM per person year, made 2.1 visits to a physician (cost $US55 visit−1) and received 1.5 courses of antimicrobials (cost $24 course−1). Their parents were absent from work for 1.9 d per person year (cost $85 d−1). Either adenoidectomy ($890 operation−1) or tympanostomy ($740) was performed on 6% of the children and the overall costs of surgery were $80 per person year at risk. In total, each single attack of acute OM cost $228. The average annual costs per child younger than 2y were $1040, those for children aged 2—3 y $283 and those for children older than 3 y $141. The cumulative costs from age 6 mo to 7y were $2549 child−1. When the attributable risk of OM at a day care centre is taken into account, in Finland, a country with about 5 million inhabitants, OM gives rise to total annual costs of $US138 million. OM leads to considerable expenses and even expensive preventive measures would be cost‐effective. □Adenoidectomy, cost analysis, otitis media, tympanostomy
Growth hormone treatment during suppression of early puberty in adopted girls
Authors: Tuvemo T , Gustafsson J , Proos LA ,   the Swedish Growth Hormone Advisory Group
Published: August 2010

Girls adopted from developing countries often have early or precocious puberty, requiring treatment with gonadotropin‐releasing hormone (GnRH) analogues. During such treatment decreased growth velocity is frequent. The aim of this investigation was to study whether the addition of growth hormone (GH) to GnRH analogue treatment improves height velocity and final height in girls with early or precocious puberty. Forty‐six girls with early or precocious puberty adopted from developing countries were randomized for treatment with GnRH analogue or a combination of GH and GnRH analogue. After 2 y of treatment the mean growth in the GH/GnRH analogue group was significantly higher, 14.6 cm, compared to 10.9 cm in the control group. The increase in bone age did not differ, while the difference in predicted adult height increased by 2.7 cm in favour of the combination group. Although data on final height are not yet available, combined GH/GnRH analogue treatment for 2 y resulted in a higher growth velocity and predicted final height compared to GnRH analogue treatment alone. □Girls, gonadotropin‐releasing hormone, growth hormone, precocious, puberty
Vascular rings: a rare cause of common respiratory symptoms
Authors: Bakker DAH , Berger RMF , Witsenburg M , Bogers AJJC
Published: August 2010

Upper airway symptoms or dysphagia may be caused by vascular anomalies, forming a ring around the trachea, oesophagus or both. To analyse the clinical presentation, use of various diagnostic techniques, treatment and follow‐up we carried out a retrospective study of 38 children who had been diagnosed with a vascular ring between 1981 and 1996. We found 74% of the vascular rings to be symptomatic, with inspiratory stridor and wheezing as the main complaints. The delay between the onset of symptoms and diagnosis of a vascular ring in patients without associated anomalies ranged from 1 to 84 mo. Associated anomalies were found in 53% of cases and 80% of these anomalies consisted of associated cardiovascular malformations. Oesophagography proved to be a valuable diagnostic technique when a vascular ring was suspected. Echocardiography appeared to be of little value for the diagnosis of a vascular ring, but was essential to exclude associated cardiovascular malformations. Although angiography has always been considered to be the gold standard in the determination of the exact anatomy of vascular rings, increasing evidence is available that CT scan or MRI may replace this role. Mortality was related to co‐existent tracheal deformities in 5/6 cases. Of the remaining, preoperatively symptomatic patients, relief of symptoms was achieved immediately after surgery in 43% and within 4 y after surgery in 57%. Prolonged and recurrent respiratory complaints or dysphagia in infancy or childhood should alert the paediatrician to the possibility of a vascular ring. □Associated cardiovascular malformations, childhood, clinical presentation, diagnostic techniques, follow‐up, surgical management, vascular ring
A prevalence study of celiac disease in persons with Down syndrome residing in the United States of America
Authors: Pueschel SM , Romano C , Failla P , Barone C , Pettinato R , Chiodo A Castellano , Plumari DL
Published: August 2010

In order to estimate the prevalence of celiac disease in persons with Down syndrome, 105 patients with this chromosomal disorder residing on the East Coast of the United States of America were enrolled in this study. IgA and IgG antigliadin antibodies (AGA) were determined using a fluorescent immunoenzymatic assay, and antiendomysium antibodies (AEA) were measured with immunofluorescence on monkey oesophagus. Of the 105 patients, 5 were positive for AEA, 4 were positive for IgG AGA, and 1 was positive for IgG AGA and AEA. Of the five patients with high titres of AEA, four consented to a jejunal biopsy, which revealed significant villous atrophy. Thus, 4 (possibly 5) patients in this cohort of 105 individuals with Down syndrome have celiac disease. □Antiendomysium antibodies, celiac disease, Down syndrome, IgG and IgA antigliadin antibodies
Adverse drug reactions to unlicensed and off‐label drugs on paediatric wards: a prospective study
Authors: Turner S , Nunn AJ , Fielding K , Choonara I
Published: August 2010

To determine the incidence of adverse drug reactions (ADRs) to unlicensed and off‐label drugs used in paediatric inpatients, we carried out prospective surveillance on five different paediatric wards in a regional children's hospital for 13 wk. Comparison of the use of each drug with its summary of product characteristics was made to determine whether the drug was used in an unlicensed or off‐label manner. The presence of an ADR was determined using previously defined criteria. In total, 4455 courses of drugs were administered to 936 patients in 1046 admissions. In 507 (48%) of the 1046 admissions, patients received one or more unlicensed or off‐label drugs. ADRs occurred in 116 (11%) of the 1046 patient admissions. ADRs were associated with 112 (3.9%) of the 2881 licensed drug prescriptions and 95 (6%) of the 1574 unlicensed or off‐label drug prescriptions. Use of drugs in an off‐label or unlicensed manner to treat children is widespread. ADRs are a significant problem following unlicensed or off‐label drug prescriptions. □Adverse drug reactions, children, off‐label, unlicensed
Consequences of pulmonary inflations (sighs) on cerebral haemodynamics in neonates ventilated by high‐frequency oscillation
Authors: Cantagrel S , Cloarec S , Sue AL , Chamboux C , Tessier V , Saliba E , Laugier J
Published: August 2010

High‐frequency oscillation (HFO) is a technique frequently used in neonatal resuscitation, but which has yet to be evaluated. The use of intrathoracic pressures may have an effect on the cerebral circulation of immature neonates. The aim of this study was to examine the variations in cerebral blood velocity and oxygenation during brief pulmonary inflations (sighs), by focusing on alveolar recruitment. In this prospective study performed in 13 intubated and ventilated neonates (α= 5%; 1‐β= 80%), mean blood velocity and Doppler Resistance Index were measured, and variations in chromophores concentrations were evaluated by near infrared spectroscopy. Brief inflations at 4 cmH2O above the mean regulated intra‐thoracic pressure did not cause any variation in the parameters measured. An explanation for this discordance with animal studies may be the level of pressure chosen, which could be more appropriate for the pulmonary compliance of neonates. □Cerebral blood flow, high frequency oscillation, newborn, NIRS
Intracardiac fungal masses in high‐risk neonates: clinical observations
Authors: Daftary AS , Patole SK , Whitehall JS
Published: August 2010

Four cases of intracardiac fungal masses occurred over 2 y amongst 7 cases of systemic candidiasis in a neonatal referral unit. The gestations and birthweights were 25, 23, 24 and 30 wk and 805, 605, 640 and 1395 g, respectively. The pedunculated, solitary right atrial masses were detected 2—17 d after diagnosing candidemia in 3 cases, whereas it was the presenting feature in the 4th. All had indwelling right atrial catheters and received multiple courses of broad‐spectrum antibiotics. The masses were removed successfully in two cases fit for surgery. None survived despite antifungal therapy, including liposomal amphotericin B at 6 mg/kg/d. Early introduction of enteral feeds, minimization of prolonged exposure to broad‐spectrum antibiotics and judicious use of central catheters may reduce the incidence of systemic candidiasis in high‐risk neonates. Surveillance echocardiography and timely surgical intervention may reduce the mortality and/or morbidity related to intracardiac fungal masses. □Candidiasis, intracardiac mass, liposomal amphotericin B, neonate
Endotracheal tolazoline: pharmacokinetics and pharmacodynamics in dogs
Authors: Paret G , Eyal O , Mayan H , Gilad E , Ben‐Abraham R , Ezra D , Barzilay Z
Published: August 2010

Tolazoline is a potent vasodilator of both arteries and veins and has a powerful effect on the pulmonary vasculature, reducing hypoxic pulmonary vasoconstriction and lowering pulmonary artery pressure. Intravenous tolazoline lowers the mean pulmonary arterial pressure and resistance and increases the cardiac index when given to infants with persistent pulmonary hypertension of the newborn (PPHN). Endotracheally administered tolazoline decreases mean pulmonary arterial pressure and pulmonary vascular resistance, and improves oxygenation without the harmful decline in systemic arterial pressure. The purpose of our study was to examine the pharmacokinetic and pharmacodynamic characteristics of endotracheal tolazoline in order to determine the relationship between endotracheal tolazoline administration, plasma concentration and its effects on the cardiovascular and respiratory systems. Tolazoline was administered endotracheally to 7 newborn dogs, and its serum concentration and the haemodynamic parameters were monitored for 270 min post‐delivery. Results are expressed as median and quartiles. It was found that 15 s after dosing, tolazoline plasma concentrations started to increase significantly above baseline levels, reaching a maximum of 2.64 (1.36;13.16) (μg/ml. The extent of tolazoline absorption was 305 (148;453) μg/min/ml. The volume of distribution was 3.4 (1.6;7.4) l/kg. The total body clearance was 12.1 (10.9;23.9)ml/min/kg and the elimination half‐life was 225 (171;303)min. Endotracheal tolazoline produced an initial short‐lived decrease in mean blood pressure in all the dogs, but thereafter the blood pressure increased gradually above baseline levels. Immediately following endotracheal tolazoline significant tachycardia developed, peaking at 90 min. Subsequently, the heart rate gradually decreased and stabilized at values above baseline for 200 min. A single endotracheal dose of tolazoline is effectively absorbed and produces measurable pharmacological effects. Determining the optimal endotracheal dose of tolazoline in the clinical setting requires additional evaluation. □Endotracheal, persistent pulmonary hypertension of the newborn, tolazoline
Neonatal Group B Streptococcal bacteraemia in India: ten years’experience
Authors: Kuruvilla KA , Thomas N , Jesudasan MV , Jana AK
Published: August 2010

Group B Streptococcus (GBS) is an infrequent cause of neonatal septicaemia in many developing countries. In a perinatal centre in India with 60,119 live births between 1988 and 1997, GBS was isolated from blood cultures of 10 babies. Thus the incidence of GBS bacteraemia was 0.17 per 1000 live births. Lethargy, respiratory distress and poor perfusion were the presenting features in eight symptomatic babies. Two babies had meningitis, three required ventilatory support and one died. There were no cases of late onset disease. The low incidence could be due to the low rate of colonisation and high prevalence of protective antibody in the mothers. □Developing country, group B streptococcus, neonate
Complement haemolytic activity (classical and alternative pathways), C3, C4 and factor B titres in healthy children
Authors: Ferriani VPL , Barbosa JE , de Carvalho IF
Published: August 2010

Values of complement lytic activity of classical and alternative pathways, assessed by measuring the time required to lyse 50% of target red blood cells, and the concentration of complement components C3, C4 and factor B were estimated in the sera of 103 healthy children aged 3 to 14 y. Age‐dependent variations were seen in the C3 and factor B concentrations, but not in C4, with the highest values found among 5–6‐y‐old children. Variations in classical and alternative lytic activity were not detected in this group of children, although the values are significantly different from our previously published data on adults, using the same kinetic assay (1). We also evaluated the relationship between the lytic activity of the classical (CPT) and alternative pathways (APT) and the levels of complement components. There were significant correlations between: APT and factor B, APT and C3, C3 and C4, C3 and factor B, and C4 and factor B concentrations. The normal ranges measured here can be used in the initial screening of Brazilian children presenting diseases involving the complement system. This study also contributes to a better understanding of the complement system ontogeny.
Bone mineral content and collagen defects in osteogenesis imperfecta
Authors: Lund AM , Mølgaard C , Müller J , Skovby F
Published: August 2010

Whole‐body and spine dual‐energy X‐ray absorptiometry was done in 63 patients with osteogenesis imperfecta aged 5 to 63 y, and the results were compared with OI types and collagen defects. Bone mineral content (BMC)‐for‐age, bone area (BA)‐for‐age, bone mineral density (BMD)‐for‐age, and BMC‐for‐BA were reduced, especially in patients with OI III/IV and/or in those with a qualitative collagen defect. BA‐for‐height was normal. Some patients with OI I and/or a quantitative collagen defect had BMD at or above −2 z‐scores. We conclude (i) that both BMC and BMD differ significantly between OI types and collagen defects, (ii) that reduced BMC‐for‐age in OI patients is due mainly to reduced height (“short bones”) and reduced BMC‐for‐BA (“light bones”), whereas BA‐for‐height (“bone width”) is normal, (iii) that most OI patients have lower than average BMC, but in some mildly affected patients brittleness may exist with only small reductions in BMC.
Child health service's response to early feeding and behaviour problems: changes in parental perceptions 1970–93
Authors: Magnusson M , Garrett MJ , Sundelin C
Published: August 2010

Objective: This health systems study was done to measure changes over time concerning parents' perceptions of feeding and behavioural problems in children 6–18 mo of age, parents' willingness to use child health services and their evaluation of the advice received. Method: The study had a repetitive cross‐sectional design. Three largely identical surveys were performed in 1970, 1988 and 1993. Questionnaires were sent to a random sample of all parents of children 6‐18 mo living in Uppsala, Sweden. Results and conclusions: The frequency of different perceived feeding and/or behavioural problems was stable or declined between 1970 and 1988, but increased in 1993. For most problems, inclination to seek help and perceived benefit of advice decreased between 1970 and 1988, but increased again in 1993. The parents sought more help and perceived the advice they received as more beneficial when the service was in the hands of paediatric nurses (1970) or of district nurses focusing on the care of infants and preschool children (1993) than when the district nurses also had responsibilities for adults and the elderly (1988). No correlation was seen with societal and sociodemographic trends. Although the cross‐sectional (hence non‐experimental) design of the study makes it impossible to prove causality, the findings suggest that parents' willingness to use the child health service and their evaluation of that service may depend in part on organization, including the degree to which nurses with “first‐line” contacts are focused on paediatric services.
Gender differences in early adolescence in factors related to outcome of healthy behaviours two years later
Authors: Berg‐Kelly K , Kullander K
Published: August 2010

In this study, 390 students comprising 89.7% of the student population answered a questionnaire on health and health behaviours, socioeconomic status (SES), school, family and peer relationships, and intentions regarding behaviours at 13.5 and 15.5 y of age. The aim was to investigate whether there were gender differences in predictors of outcome of behaviours with impact on health at 15.5 y of age. Outcome dealt with three domains: health habits, acquisition of adult lifestyles, and problem behaviours. The material was analysed for correlations. Significant results were entered into multiple regression stepwise procedures. As expected, having already initiated adult lifestyles or exhibiting problem behaviours at 13.5 y were the most important factors associated with such behaviours 2 y later. Further analyses were then limited to those students who had not started such lifestyles to see what factors kept them from doing so in a 2‐y period and what gender differences existed, if any. Results differed for the genders, with more boys being more concrete and behaviour‐oriented, representing a sample of boys with late to normal puberty. Girls more often expressed intentions regarding behaviour, which predicted positive outcomes. Both genders were prudent in most areas studied: they were well adapted at school, had positive self‐esteem and were not moving in circles where smoking and drinking were abundant. The conclusion is that young adolescents who do not start risky behaviours between the ages of 13 and 15 y live in a supportive context, which allows for positive interactions. The next step would be to investigate if alternative strategies may be used to implement similar options for those who lack such support in their natural environment.
A one‐year population‐based study of drug prescriptions for Danish children
Authors: Thrane N , Sørensen HT
Published: August 2010

We examined the pattern of prescribed drug use in Danish children and used a pharmacoepidemio‐logical prescription database to identify all reimbursed prescriptions for children aged 0‐15 y living in North Jutland County (population 95 189), Denmark, during 1997. We identified 154 189 prescriptions for 48 091 drug users. The 20 most frequently prescribed chemical substance subgroups comprised 71.3% of all prescriptions. The mean annual prescription rate was 1621/1000 children/y. Overall, 50.6% of the population received one or more prescription. In children younger than 3 y, 75.3% received prescriptions and 17.5% obtained five or more prescriptions. Systemic antibiotics, anti‐asthmatics, ophthalmologicals and dermatological corticosteroids accounted for 82% of prescriptions. One‐third of the young children received anti‐asthmatics, mainly oral beta‐2 agonists, and almost half received antibiotics, mainly broad‐spectrum penicillins. In the 7–15‐y‐olds, 39.1% received prescriptions. Hormones, antihistamines, anti‐epileptics, anti‐acne preparations and anti‐diabetics comprised an increasing proportion of prescriptions. About 20% received antibiotics and 6% anti‐asthmatics. In conclusion, the level of exposure to prescribed drugs was considerable at all ages and was highest in early childhood. Our study supports the need for epidemiological studies on the reasons for drug use and evaluation of their pharmacological effects in children.
Influence of maternal magnesium sulphate and ritodrine treatment on the neonate: a study with six‐month follow‐up
Authors: Rantonen T , Ekblad U , Grönlund J , Rikalainen H , Välimäki I , Kero P
Published: August 2010

Magnesium sulphate and ritodrine are commonly used drugs in the prevention of preterm delivery. However, the effects of these treatments on the newborn are controversial. It has previously been suggested that antenatal tocolytic magnesium sulphate decreases the incidence of cerebral palsy, but increases paediatric mortality. On the other hand, antenatal ritodrine treatment has been reported to increase the incidence of neonatal peri‐intra‐ventricular haemorrhage (PIVH). We investigated the cerebral ultrasonographic findings, neurological outcome and apparent life‐threatening events (ALTE) among 63 infants, born before 33 wk of gestation, whose mothers were antenatally treated for premature birth with ritodrine or magnesium sulphate, and for pre‐eclampsia with magnesium sulphate. Cerebral ultrasonography was performed during the first week of life and repeated before hospital discharge. The pathological findings were confirmed by a paediatric radiologist. A paediatrician and a physiotherapist performed the neurological follow‐up examination of the survivors at 6 mo of age. We found Grade 3^1 PIVH in 15% of the infants exposed to maternal ritodrine treatment, in 9% of the infants whose mothers received tocolytic magnesium treatment, and in none of those exposed to maternal magnesium treatment for pre‐eclampsia (p = 0.19). However, no differences were observed in 6‐mo development or in the rate of paediatric mortality and ALTE among these three study groups. Because of the retrospective design and the limited number of subjects, the results of this study must be interpreted with caution.
Adverse events in intensively treated children and adolescents with type 1 diabetes
Authors: Nordfeldt S , Ludvigsson J
Published: August 2010

The main objective of this study was to examine the relation between adverse events and degree of metabolic control and multiple‐dose treatment. A total of 139 children, aged between 1 and 18 y, prospectively registered severe hypoglycaemia with or without unconsciousness, as well as hospitalized ketoacidosis, during 1994‐95. Treatment from onset was multiple‐dose insulin (>95%≥ 4 doses) combined with intense training and psychosocial support. Median HbA1c was 6.9% (ref. 3.6‐5.4%). The incidence of severe hypoglycaemia with unconsciousness was 0.17 events per patient‐year, having decreased from the 1970s to the 1990s, parallel to a change from 1–2 to ≥ 4 doses per day. There was no correlation or association to the year mean HbA1c for severe hypoglycaemia. Severe hypoglycaemic episodes in 1995 correlated to severe hypoglycae‐mic episodes in 1994 (r= 0.38; p< 0.0001). Severe hypoglycaemia with unconsciousness increased during the spring season, and according to case records the assumed causes were mainly mistakes with insulin, food and exercise. Ketoacidosis was rare: 0.015 episodes per patient‐year. We conclude that multiple‐dose insulin therapy from the very onset of diabetes, combined with adequate self‐control, active problem‐based training and psycho‐social support, may limit severe hypoglycaemia and ketoacidosis. Strategies aimed at minimizing severe hypoglycaemia without compromising metabolic control need to be evaluated.
A metabolic balance study in term infants fed lactose‐containing or lactose‐free formula
Authors: Moya M , Lifschitz C , Ameen V , Euler AR
Published: August 2010

Lactose‐free (L –) formulas are recommended for infants with conditions affecting lactose digestion. Cows' milk protein‐based formulas containing other carbohydrate sources are most often used for such infants. This study compared fat absorption and absorption and retention of nitrogen, calcium, phosphorus, and magnesium in term infants fed either a L – or standard lactose‐containing (L+) bovine milk protein‐based formula. Data from three single‐centre, double‐blind, randomized, parallel‐group metabolic balance studies were combined. After a 4–7‐d equilibration period on either L – or L+ formula, a 72‐h balance study was performed. Twenty infants received L – and 21 received L+ formula. Besides the L – group having a higher percentage of males (65%) and the L+ group a higher percentage of females (52.4%), other baseline measurements were similar. The majority of nutrient balance data was similar between the two groups. Exceptions were relative nitrogen absorption, calcium intake and calcium retention, magnesium retention, and faecal phosphorus excretion, all of which were significantly higher in the L – group. Vitamin D supplementation did not significantly affect either calcium or phosphorus data. This new L – formula provided similar nutrients and is a suitable alternative to a L+ formula in term infants requiring L – feedings.
Increased prevalence of overweight in adolescent girls with type 1 diabetes mellitus
Authors: Domargård A , Särnblad S , Kroon M , Karlsson I , Skeppner G , Åman J
Published: August 2010

Height and weight were measured in young patients with type 1 diabetes up to the age of 22 y. We found no difference between birth length standard deviation scores (SDS), final height SDS and target height SDS. The study group of 89 diabetic boys and girls did not differ in final height from age‐ and sex‐matched healthy controls. SDS for height at diagnosis, +0.17 ± 1.10, exceeded that for final height, −0.06 ±0.97 (p = 0.037). Height SDS decreased between the ages of 11 and 18 (p <0.01). In diabetic girls, but not boys, final height SDS was significantly related to mean HbA1c during puberty (r=−0.40; p = 0.025). Weight gain occurred from age of menarche in girls with type 1 diabetes. At the age of 18, diabetic girls were 6.5 kg heavier and had 2.7 kg/m2 higher body mass index (BMI) than control girls (p<0.001). Diabetic boys were not heavier than control boys. There was a significant relationship between mean HbA1c during puberty and BMI at the age of 18 in diabetic girls (r= 0.47; p = 0.009). In diabetic females, body weight remained unchanged, HbA1c improved and the dose of insulin was significantly reduced between 18 and 22 y of age. The HbA1c improvement was most marked in patients with poor metabolic control. In conclusion, although mean final height was normal in young patients with type 1 diabetes, growth was increased before diagnosis and pubertal growth spurt was reduced. Adolescent overweight was overrepresented; it related to poor metabolic control in females with diabetes, but showed no further acceleration in early adulthood.
Surfactant‐deficient respiratory distress after elective delivery at ‘term’
Authors: Madar J , Richmond S , Hey E
Published: August 2010

Babies of 37‐41 wk gestation are, by international convention, said to be born at ‘term’, but some still develop respiratory distress. It is not clear how mature a baby has to be to be free of risk of primary surfactant deficiency. An area‐based retrospective study of all the 179 701 babies of 34 or more weeks' gestation born alive in a defined area of the north of England in 1988‐92 identified 149 babies with features of respiratory distress typical of surfactant deficiency severe enough to be managed with ventilatory support and with no evidence of aspiration or intrapartum infection. Gestation was carefully cross‐validated against antenatal information, including at least one ultrasound assessment in the first half of pregnancy. Thirty‐six of these babies were born at or after 37 wk gestation. Only 4 of the 35 delivered at 37‐38 wk went into spontaneous labour. Seven became ill enough to be candidates for ECMO and two died. A review of all neonatal deaths in the study area between 1981 and 1995 identified four similar deaths in 1981‐87 and two in 1993‐95. Babies who are not premature, using the internationally agreed definition, can show signs of potentially lethal pulmonary immaturity at birth, especially if subjected to pre‐labour Caesarean delivery. Those born at 37‐38 wk are 120 times more likely to receive ventilatory support for surfactant deficiency than those born at 39‐41 wk. Elective delivery should only be undertaken before 39 wk gestation for good medical reasons.
Measurements of attention deficits and impulsivity: a Swedish study of the Gordon Diagnostic System
Authors: El‐Sayed E , Hooft I van't , Fried I , Larsson J‐O , Malmberg K , Rydelius P‐A
Published: August 2010

The Gordon Diagnostic System (GDS) is a portable easily operated computerized tool developed to measure impulse control, attention and vigilance. In 1988, it was standardized for use among American children. The aim of this study was to evaluate the GDS for use among Swedish children. A clinical sample of 71 Swedish children, mean age 10.5 y, fulfilling the ADHD criteria according to the DSM‐IV was compared with a control sample of 88 children, mean age 10.2 y, with no known psychiatric diagnosis. The clinical sample showed lower GDS scores in all age groups, with some exceptions. The GDS scores were not associated with gender, but strongly associated with age, especially in the control sample. The accuracy of the GDS referring a specific child to either of the samples was, as expected, not impressive. With respect to the practical usefulness, the GDS was well accepted by the children and parents in both samples. The findings in age variation and when comparing children with ADHD and controls are in agreement with results from other studies.
Reproducibility of a survey questionnaire for the investigation of low back problems in adolescents
Authors: Staes F , Stappaerts K , Vertommen H , Everaert D , Coppieters M
Published: August 2010

A test‐retest design was used to investigate the reproducibility of the results obtained using a survey questionnaire for low back problems in adolescents. A 1‐wk interval between test and retest was chosen. Participants were recruited from four schools. Selection of schools was based on geographic location, size of the school and educational level. Sixty‐seven adolescents (mean age= 16.62 y; SD = 0.57; range = 16–18) suffering from low back problems agreed to participate. A questionnaire on perceived characteristics of back problems and functional limitations was designed. Item completion rate and the reproducibility of results were investigated by means of percentage agreement and (weighted) kappa. High levels of reproducibility were found for items that evaluated perceived characteristics of back problems and functional limitations (Kw= 0.70‐0.93). Results suggest that the questionnaire used in the present study provided reproducible information. Detailed information on low back problems in adolescents could be obtained using this questionnaire.
Hospitalization for varicella in central Israel
Authors: Maharshak N , Somekh E
Published: August 2010

In order to determine the impact of chickenpox on the general population, we conducted a retrospective study in four medical centres in central Israel. Hospital records of 182 patients discharged with the diagnosis of varicella during a 3‐y period were reviewed. The patients' mean age was 7.9 y. A total of 14 patients (8%) were immunocompromised. Bacterial skin or soft tissue infection was the most common complication (32%). Other complications included gastrointestinal manifestations (14%), pneumonia (12%), febrile seizures (10%) and CNS complications (9%). Twenty‐one percent of patients were discharged with the diagnosis of uncomplicated varicella. One patient died, one underwent liver transplantation for liver failure and four had persistent neurological sequelae. Forty‐four patients (24%) received acyclovir for an average duration of 5.7 d. The mean hospital stay was 4.3 d; it was significantly longer for patients with CNS complications (8 d). We estimate that the hospitalization rate in Israel is 1/285 cases of chickenpox. While mortality from varicella was found to be relatively rare, the economic burden of this infection in Israel is quite substantial.
Nucleotide and polyamine levels in colostrum and mature milk in relation to maternal atopy and atopic development in the children
Authors: Duchén K , Thorell L
Published: August 2010

The prophylactic benefit of breastfeeding against atopic disease is still controversial. It seems to be limited to infants with genetic propensities to allergy in combination with late solid food introduction. Lower levels of n‐3 polyunsaturated fatty acids in human milk have been related to atopy in children, stressing a non‐specific role of nutritional components in the development of atopy. Nucleotides and polyamines have been related to intestinal integrity and immune function in infancy. The main sources of these nutrients are human milk nucleotides and polyamines early in life. Our aim was to study the composition of nucleotides and polyamines in colostrum and mature milk from atopic and non‐atopic mothers and the relationship to sensitization against egg, milk or cat in their children during the first year of life. The nucleotide/nucleoside and polyamine levels were measured by HPLC in colostrum and in milk at 3 mo of lactation from mothers of 21 atopic and 14 non‐atopic children. Among the mothers, 10 were atopic and 25 non‐atopic. The nucleotides cytidine monophosphate (CMP), uridine monophosphate (UMP), adenosine monophos‐phate (AMP) and guanosine monophosphate (GMP) and the nucleosides cytidine and uridine were detected in human milk. In colostrum, CMP dominated, and the levels increased in mature milk, while the levels of the other compounds remained constant. The nucleotide/nucleoside composition was similar in colostrum from all mothers independent of the development of sensitization in their babies, except for the higher cytidine levels in mature milk from atopic mothers of atopic babies, as compared to healthy mothers of atopic babies. The polyamine levels were similar in colostrum from atopic and non‐atopic mothers. However, putrescine and spermine levels were lower in mature milk from atopic mothers than non‐atopic mothers. No relationship was found between milk putrescine and spermine levels and development of atopy in the children. In conclusion, low levels of human milk putrescine and spermine seem to be related to maternal atopy
Effect of age on cerebrospinal fluid levels of metabolites of biopterin and biogenic amines
Authors: Komori H , Matsuishi T , Yamada S , Ueda N , Yamashita Y , Kato H
Published: August 2010

We identified an age effect on biopterin and biogenic amine metabolites in the cerebrospinal fluid from 56 neurologically normal patients, aged 1 mo to 80 y. The levels of total and reduced forms of biopterin, homovanillic acid, and 5‐hydroxyindoleacetic acid were found to peak during the first year of life. The levels of these metabolites then gradually decreased, plateauing at the age of 20 y. We found significant correlations between biopterin, homovanillic acid, and 5‐hydroxyindoleacetic acid.
High rate of maternal‐infant transmission of hepatitis G virus in HIV‐1 and hepatitis C virus‐infected women
Authors: Palomba E , Bairo A , Tovo P‐A
Published: August 2010

The prevalence of hepatitis G virus (HGV) infection was investigated in 56 mothers with both human immunodeficiency virus type 1 (HIV‐1) and hepatitis C virus (HCV) infection. Thirty‐three (58.8%) women had markers of HGV infection, including 7/15 (46.6%) with no history of parenteral exposure to blood. Sixteen (48%) had HGV RNA in serum by a polymerase chain reaction assay, and 17 (52%) had antibody to E2 viral protein. No woman was positive for both markers. Of 20 infants born to the 16 mothers with HGV viremia, 9 (45%, 95% CI 34‐56%) acquired the infection. No infected child seroconverted to HGV during the first year of life. At the latest visit (mean: 37.1 mo, range: 9–89 mo) 7 children were still seronegative HGV RNA carriers, 1 was both RNA‐ and antibody‐negative, while 1 RNA‐negative child had developed the E2 antibody. Of the 20 HGV‐exposed infants, 2 contracted HCV and 1 HIV‐1 (all 3 with HGV coinfection). No abnormalities in clinical findings and ALT levels were observed throughout the follow‐up period in the six children with HGV infection alone. Our findings show that HGV infection is widespread among HIV‐1‐ and HCV‐infected women. Maternal‐infant transmission of HGV is common and occurs independently from that of HIV‐1 and HCV in women with triple infection. Most perinatally HGV‐infected children develop persistent infection with no clinical or biological signs of liver damage, at least in the first years of life.
Postural differences in cardiac dynamics during quiet and active sleep in low birthweight infants
Authors: Sahni R , Schulze KF , Kashyap S , Ohira‐Kist K , Fifer WP , Myers MM
Published: August 2010

To study the effects of body position (supine versus prone) on changes in cardiac inter‐beat interval during quiet and active sleep, 6‐h continuous electrocardiographic recordings and simultaneous minute‐by‐minute behavioural activity state assignments were made in 61 healthy, growing, low birthweight infants. The infants weighed 795‐1600 g at birth and ranged between 30–38 wk in postconceptual age. Infants were randomly assigned to the supine or prone position for the first 3 h of each study; the position was reversed for the second 3 h. Higher heart rates and lower time and frequency domain measures of inter‐beat interval variability were observed in the prone position as compared to the supine position, during both quiet and active sleep. In addition, an analysis of consecutive increases and decreases in the instantaneous heart rate revealed a lower incidence of sustained accelerations or decelerations in the prone position. Although consistent findings concerning inter‐beat interval variability and sleeping position were obtained from all analytic techniques, the differences derived from analysis of consecutive inter‐beat changes were the most robust. These differences in multiple measures of cardiac rate and rhythm between prone and supine positions suggest that autonomic control of the heart is altered by body position, the net effect on heart rate being increased sympathetic dominance.
A Danish adaptation of the Pain Coping Questionnaire for children: preliminary data concerning reliability and validity
Authors: Thastum M , Zachariae R , Schøler M , Herlin T
Published: August 2010

The aim of this study was to determine the reliability and validity of a Danish translation of the Pain Coping Questionnaire (PCQ) for children in Danish children. The PCQ was translated using a translation‐back‐translation method. The subjects were 352 healthy children and 40 children with juvenile arthritis (JA), aged 8–17 y. Sixteen of the JA children were divided into a high‐pain group (n= 7) and a low‐pain group (n= 9). The results were factor analysed using principal component analysis with varimax rotation. Clinical pain intensity was measured using visual analogue scales (VAS) from the Varni/Thompson Pediatric Pain Questionnaire. Experimental pain was induced using a cold pressor pain paradigm and outcome measures were pain intensity, pain discomfort and tolerance to cold pressor pain. A seven‐factor solution emerged as the most consistent factor structure. Four subscales, Seeking Social Support (SSS), Cognitive Distraction (CD), Externalizing (EXT) and Internalizing/Catastrophizing (INT), corresponded with the parallel subscales proposed by Reid et al. (Pain 1998; 76: 83–96). Two subscales, Positive Self‐Statements (PSS) and Behavioral Distraction (BD), were composed of four of the five items from the previously proposed subscales. One subscale, Information Seeking/Problem Solving (IP), consisted of items from two subscales proposed by Reid et al., i.e. Information Seeking and Problem Solving. Internal consistencies of the subscales were acceptable, with reliability coefficients ranging from 0.60 (BD) to 0.83 (IP) and with test‐retest reliabilities between 0.59 and 0.78. Low‐pain JA patients showed significantly higher levels of BD than High‐pain JA patients (p < 0.05). Greater utilization of PSS and BD was associated with less patient‐reported present pain and less average everyday pain (p < 0.05‐0.01), and greater utilization of INT was significantly associated with higher experimental pain intensity (p < 0.01). These preliminary findings provide support for the reliability and validity of the Danish modification of the PCQ in a Danish population and for the hypothesis that paediatric pain‐coping strategies are associated with the intensity of clinical and experimental pain.
Double‐blind, randomized, controlled trial of zinc or vitamin A supplementation in young children with acute diarrhoea
Authors: Faruque ASG , Mahalanabis D , Haque SS , Fuchs GJ , Habte D
Published: August 2010

In a double‐blind, controlled trial with a factorial design, 684 patients (aged 6 months to 2 y; excludes 6 early dropouts) with acute watery diarrhoea of 3 d or less and some dehydration, who were attending a hospital, were randomly assigned to 4 groups to receive: (a) vitamin A 4500 μg retinol equivalent daily for 15 d; (b) 14.2 mg elemental zinc as acetate for the first 417 patients and 40 mg of the remaining 273 patients randomized to this group for 15 d; (c) both vitamin A 4500 μg retinol equivalent and zinc at the above doses daily for 15 d; or (d) placebo mixtures for 15 d. Patients were observed in the hospital for 24 h and followed up at home for 15 d. All received ascorbic acid 30 mg with each dose of medicine or placebo. Zinc supplementation was associated with a reduced duration of diarrhoea (13%, p= 0.03) and markedly reduced rate (43%, p= 0.017) of prolonged diarrhoea (<7 d). Vitamin A supplementation was associated with a nonsignificant trend for reduced rate of prolonged diarrhoea (p= 0.089). In conclusion, zinc supplementation as adjunct therapy had a substantial impact on the rate of prolonged diarrhoea and some impact on duration and may be beneficial in children with diarrhoea in developing countries.
Helicobacter pylori gastritis in children: efficacy of 2 weeks of treatment with clarithromycin, amoxicillin and omeprazole
Authors: Tirén U , Sandstedt B , Finkel Y
Published: August 2010

Thirty‐eight children with Helicobacter pylori gastritis diagnosed by histopathology, and/or bacteriological culture were treated with omeprazole, amoxicillin and clarithromycin. Follow‐up endoscopy was performed in 34 children. Outcome was measured by negative histology and culture for H. pylori. Six patients were excluded. Of the 32 remaining children eradication was achieved in 75% (95% confidence interval 60–90%).
Secular changes in anthropometric data in cystic fibrosis patients
Authors: Laursen EM , Koch C , Petersen JH , Müller J
Published: August 2010

The aim of this study was to study the secular changes in anthropometric data over calendar time in patients with cystic fibrosis (CF). Growth curves were constructed for 270 patients based on height and weight registrations from the medical files. Height, body mass index (BMI), magnitude of pubertal peak height velocity (PHV) and age at PHV were analysed for possible secular changes from the 1960s to the 1990s. There was a significant change in height over calendar time in only 1 of 12 age groups. BMI showed a significant increase in 10‐ and 15‐y‐old boys and girls and in 5‐y‐old girls. The magnitude of PHV changed significantly over time, whereas age at PHV was constant. No significant changes in height and age at PHV over calendar time were observed; this was probably due to a selection bias since the oldest patients, who survived to be part of the present investigation, represented milder forms of the disease. The increase in BMI and change in magnitude of PHV over calendar time may reflect the improvement in treatment leading to a better survival and clinical status through puberty. The increase in BMI and change in magnitude of PHV were sufficient to overcome the selection bias from older patients with milder disease.
Growth parameters in children with retinoblastoma
Authors: Peek AML , Schouten‐van Meeteren AYN , Delemarre‐van de Waal HA , Imhof SM
Published: August 2010

The purpose of this study was to compare growth parameters of retinoblastoma patients with siblings and the normal Dutch population. Height, weight, head circumference and sitting height were measured in 67 patients and 63 controls. Target height was calculated based on the parental height of retinoblastoma patients. Standard deviation scores and population‐based percentiles were calculated and used for statistical analysis. Retinoblastoma patients had larger head circumferences than the Dutch population and their siblings, and their weight was also higher than the Dutch population. Height and target height showed no differences from the Dutch population. Retinoblastoma patients had a greater sitting height than the Dutch population. Sample numbers were too small to reach statistical significance when comparing the sitting height of retinoblastoma patients with their siblings. No obvious explanations are available for these differences.
Confidential enquiry into deaths due to prematurity
Authors: Cartlidge PHT , Jones HP , Stewart JH , Drayton MR , Ferguson DS , Matthes JWA , Minchom PE , Moorcraft J
Published: August 2010

The aim of this study was to audit the management of neonatal respiratory distress syndrome (RDS) in a geographically defined population using a retrospective peer review of case notes. The subjects were 49 infants of 24–36 wk gestation with a birthweight > 499 g, and dying as a consequence of prematurity at <1 y of age in Wales during 1996. Forty‐four infants (90%) were delivered in a unit with staff experienced in the management of preterm birth. Of the 30 infants <30 weeks'gestation, 29 (97%) received neonatal intensive care on a (sub)regional unit. Predelivery corticosteroids were indicated in 34 cases and administered in 31 (91%). Resuscitation at birth was indicated in 47 infants and conducted satisfactorily in 42 (89%). Temperature on admission to the neonatal unit was not recorded in 7 infants; in the other 42 it was >35.5°C in 21 (50%). Early surfactant therapy was administered to 31/34 (91%) infants still intubated 120 min after birth, but was given within 30 min to only 8 (24%). Mechanical ventilation was assessed in 41 infants and considered to be good in 23 (56%). Cardiovascular therapy was evaluated in 40 infants requiring active support and considered to be good in 31 (78%). We concluded that neonatal RDS was generally well managed, thermal care during resuscitation was poor, surfactant should be administered more promptly, and deficiencies in the management of ventilation were common and related mainly to poor anticipation and a slow response to problems.