bluuebunny/crossref_metadata_2025 huggingface dataset:
Undernutrition and childhood infections: a prospective study of childhood infections in relation to growth in the Sudan
Authors: Kossmann J , Nestel P , Herrera MG , El‐Amin A , Fawzi WW
Published: August 2010

The relationships between both diarrhoea and respiratory infections and linear and ponderal growth were prospectively examined among 28 753 Sudanese pre‐school children. Childhood infections were significantly and inversely associated with attained height and attained weight and gain in height and weight over a 6‐mo period. They were significantly and positively associated also with stunting after adjusting for age, gender, socio‐economic status, dietary variables and previous morbidity. Attained height was on average 17 mm lower (95% CI [‐19 ‐151) for children with diarrhoea and 11 mm lower (95% CI [‐3 ‐91) for children with complicated cough than for those without these symptoms. The association between morbidity and attained weight was significant for diarrhoea and complicated cough, but the differences between children with and without symptoms were negligible. The risk of being stunted 6 mo later was 1.38 times (95% CI [1.20 1.59]), 1.29 times (95% CI [0.97 1.721) and 1.32 times (95% CI [1.13 1.541) greater among normally‐nourished children with diarrhoea, febrile diarrhoea and fever, respectively, than among children without these symptoms. The difference in attained height between children with diarrhoea or complicated cough and those without symptoms increased with age, and was larger among the non‐breastfed children compared with breastfed children.

Conclusion: The results underline the need to reduce child morbidity to prevent the impairment of growth and development.
Ethical issues in parental decision‐making. An interview study of mothers of children with hypoplastic left heart syndrome
Authors: Vandvik IH , Førde R
Published: August 2010

It is unclear how parents make life‐and‐death decisions on behalf of their children. To address this issue we interviewed 20 mothers whose children were born with hypoplastic left heart syndrome (HLHS), 10 whose child survived the operations and 10 mothers who chose comfort care. Semi‐structured interviews lasting from 1.5 to 3.5 h took place on median 4.6 (range 2 .5–6) years after birth. The mothers who chose comfort care had more years of education p= 0.03), reported a better childhood environment (p= 0.05) and had more often been employed in the healthcare services. The two groups described the information received in similar terms. The main motive for choosing surgery was that this was perceived to be the only acceptable choice. The motive for choosing non‐treatment was to prevent the child from suffering.

Lack of knowledge about long‐term outcome. a state of shock and short time to deliberate limit the parents’possibilities for making autonomous choices. Autonomous decisions may be neither possible nor desirable for all parents. The care perspective, which highlights the parents’preferences, resources and values, should represent ethical guidelines for care providers willing to decide on behalf of the child.
High serum cardiac troponin T concentrations in preterm infants with respiratory distress syndrome*
Authors: Trevisanuto D , Zaninotto M , Altinier S , Plebani M , Zanardo V
Published: August 2010

In preterm infants with respiratory distress syndrome (RDS), cardiac function is negatively influenced by the severity of the lung disease. On day 2 of life, cardiac troponin T (cTnT), biochemical marker of myocardial injury, was measured in 46 preterm infants (gestational age ≤32 wk), 26 with RDS and 20 without: median (range) 0.38 (0.02–1.57) μgL vs 0.13 (0.02–0.85) μgL, respectively.

Conclusion: High cTnT concentrations in preterm infants with RDS suggest the presence of myocardial damage in this group of high‐risk patients.
Growth hormone in short children: medically appropriate treatment
Authors: Macklin R
Published: August 2010

Bolt and Mul argue persuasively against the “disease” approach and the “client” approach in addressing the question of whether growth hormone for short children properly belongs in the medical realm. Their own preferred approach, the “suffering” approach, is superior to the others but has practical problems that would arise in its application. An additional ethical issue, not addressed by Bolt and Mul, relates to justice in providing access for children from families of limited financial means to growth hormone treatment.
Spontaneous speech at 6½ years of age in children who required neonatal intensive care in 1986–1989
Authors: Jennische M , Sedin G
Published: August 2010

Spontaneous speech at 6½y of age was studied in a follow‐up of 230 children born in 1986–89 who had required neonatal intensive care (NIC) and 71 fullterm neonatally healthy control children. Eight aspects of spontaneous speech were examined: Information, speech motor function, sound pattern, word finding, word selection, grammar, interaction and motivation. The results were analysed in relation to gestational age groups (group I, 23–31 wk; subgroup IA, 23–27 wk; IB, 28–31 wk; group II, 32–36 wk; group III, >36 wk) and a separate group of children with congenital malformations (IWCM). Between 66.7% (group IA) and 55.7% (group III) had no obvious deviations in any aspect of spontaneous speech compared with 80.3% of controls. Children born at <32 wk of gestation (group I) had few pronounced deviations in speech motor function or formal aspects of spontaneous speech. No ability, or hardly any ability, in an aspect of spontaneous speech was only found in children born at >32 wk. Deviations in prosody and poor facial expressions accompanying spontaneous speech were more common in group I than in controls.

Conclusion: Most children who needed intensive care neonatally had well‐developed spontaneous speech.
Epilepsy in a representative series of Rett syndrome
Authors: Steffenburg U , Hagberg G , Hagberg B
Published: August 2010

In a representative series of 53 females with Rett syndrome (RS), aged 5–55 y, a history of epilepsy was present in 50 (94%), 45 of whom had 5‐y active epilepsy. Compared with severe mental retardation in general, the median age of seizure onset was significantly later (4 vs 0.8 y) and partial complex seizures were more frequent (54% vs 23%). Neonatal seizures had occurred in only one and infantile spasms in none compared with 26% and 12%. After teenage, the severity of epilepsy tended to decrease, i.e. lower seizure frequency and relatively more partial seizures. The rate of being seizure‐free for 1 y was 8% after 10 y and 40% after 27 y of epilepsy duration. Frequent seizures were associated with smaller head circumference.

Conclusion: This epilepsy profile could fit in with present‐day knowledge of RS as a form of dendrito‐synaptogenic developmental failure with mainly late postnatal consequences, as well as being a relatively stationary condition in adulthood.
Oral sucrose compares favourably with lidocaine‐prilocaine cream for pain relief during venepuncture in neonates
Authors: Abad F , Díaz‐Gómez NM , Domenech E , González D , Robayna M , Feria M
Published: August 2010

To compare the relative efficacy of oral sucrose versus EMLA® cream for pain relief during venepuncture, 51 full‐term newborns (38M, 13F; postnatal age <4d) in a stable condition were randomly allocated to one of four treatment groups: placebo (2 ml spring water); 2 ml sucrose 24% w/v; 1 g lidocaine‐prilocaine 5% cream (EMLA); or EMLA plus sucrose. Water or a single dose of sucrose solution was administered orally 2 min before venepuncture. EMLA cream was applied in the antecubital fossa 45–60 min before venepuncture and covered by a Tegaderm® dressing. A pacifier was given before skin puncture, but it was not actively held or replaced during the procedure or observation periods. In total, 55 venepunctures were performed blindly, always for clinical reasons. As indicators of pain, the total crying time was recorded and heart rate, respiratory rate and arterial oxygen saturation were measured blindly at baseline, immediately post‐venepuncture, and 2 and 4 min afterwards. The main effects observed were: (i) time spent crying decreased significantly in the sucrose alone (p= 0.001) and EMLA plus sucrose (p= 0.008) groups; (ii) the above treatments attenuated significantly (p < 0.05) the immediate heart rate response to pain; and (iii) the concomitant use of EMLA did not increase further the analgesic efficacy of sucrose.

Conclusion: This study shows that a 24% oral sucrose solution compares favourably with EMLA cream as a safe and cheap analgesic procedure to decrease pain responses to venepuncture in newborns.
Clinical aspects on neonatal cholestasis based on observations at a Swedish tertiary referral centre
Authors: Fischler B , Papadogiannakis N , Nemeth A
Published: August 2010

The aim of the study was to investigate the clinical aspects of neonatal cholestasis. The medical records of 85 cholestatic infants were retrospectively reviewed. A majority of the patients were referred from other parts of the country. The most common diagnoses were extrahepatic biliary atresia (n= 30 patients), α1‐antitrypsin deficiency (n=11) and progressive familial intrahepatic cholestasis (n= 11). On presentation, the biliary atresia group had higher mean serum values of bilirubin, G‐GT and cholesterol than the patients with intrahepatic cholestasis, with no significant differences noticed for any other biochemical parameter. A lack of excretion on hepatobiliary scintigraphy was noticed in all investigated patients with biliary atresia, but also in 9 of 34 patients with intrahepatic neonatal cholestasis. There was no statistical correlation between the age at portoenterostomy and the outcome in patients with biliary atresia. However, both the detection of a partial flow on perioperative cholangiogram and the establishment of a non‐icteric phase within 6 mo after the portoenterostomy correlated to a good outcome. Eight of 11 patients with progressive familial intrahepatic cholestasis were treated with a biliary diversion procedure, five of eight experienced a sustained cholestatic remission.

Conclusions: Progressive familial intrahepatic cholestasis may be a more common cause of neonatal cholestasis in Sweden than reported elsewhere and that the experience with biliary diversion is positive. While early referral in patients with extrahepatic biliary atresia remains important, a portoenterostomy should be attempted also in patients referred after 3 mo of age.
Detection of bacterial DNA by PCR and reverse hybridization in the 16S rRNA gene with particular reference to neonatal septicemia
Authors: Shang S , Chen Z , Yu X
Published: August 2010

Aim: The clinical diagnosis of sepsis is difficult, particularly in neonates. It is necessary to develop a rapid and reliable method for detecting bacteria in blood and cerebrospinal fluid (CSF) Polymerase chain reaction (PCR) and reverse hybridization of the 16S rRNA gene would permit fast and sensitive determination of the presence of bacteria and differentiate gram‐positive bacteria from gram‐negative ones in clinical specimens. Methods: We developed a pair of primers according to the gene encoding 16SrRNA found in all bacteria. DNA fragments from different bacterial species and from clinical samples were detected with PCR, and with reverse hybridization using a universal bacterial probe, a gram‐positive probe and a gram‐negative probe. Results: A 371 bp DNA fragment was amplified from 20 different bacterial species. No signal was observed when human DNA and viruses were used as templates. The sensitivity could be improved to 10T‐12 g. All 26 culture‐positive clinical samples (22 blood samples and 4 CSF samples) were positive with PCR. The gram‐negative and gram‐positive probes hybridized to clinical samples and to known bacterial controls, as predicted by Gram's stain characteristics.

Conclusions: Our results suggest that the method of PCR and reverse hybridization is rapid, sensitive and specific in detecting bacterial infections. This finding may be significant in the clinical diagnosis of sepsis in neonates.
Neurological development up to the age of four years of extremely low birthweight infants born in Southern Finland in 1991–94
Authors: Salokorpi T , Rautio T , Sajaniemi N , Serenius‐Sirve S , Tuomi H , Wendt L von
Published: August 2010

A total of 142 infants with birthweights of less than 1000 g were examined at the age of 4 y by a child neurologist, by a neuropsychologist and by an occupational therapist in order to establish the rate of neurological disorders. A total of 57 (40%) of the children had normal neurological development, 52 (37%) had minor neurological disorders, 27 (19%) were diagnosed with cerebral palsy, and 6 (4%) were mentally retarded (IQ <71) with no motor disability. The rate of cerebral palsy was identical with the figure at age 2y, but the rate of minor neurological disorders increased from 25% to 37%.

Compared with international rates, we found a higher rate of cerebral palsy, but the incidence of minor neurological disorders corresponded with figures published previously.
Reed‐Sternberg cells in atypical primary EBV infection
Authors: Bitsori M , Stiakaki E , Tzardi M , Kalmanti M
Published: August 2010

The presence of Epstein‐Barr virus (EBV) in the Hodgkin's/Reed‐Sternberg (HRS) cells of a significant proportion of cases of Hodgkin's lymphoma (HL) is a matter of consideration when a case of presumptive HL has to be differentiated from infectious mononucleosis (IM). A 15‐y‐old boy was admitted with a presumptive diagnosis of extranodal HL, based on the biopsy of a painless ulcer on the right mandibular alveolar crest. Histologic examination of the lesion was consistent with mixed cellularity HL. The patient additionally presented with hepatosplenomegaly and regional lymphadenopathy. Serology for EBV was indicative of acute infection. Histological examination of regional lymphoid tissue was consistent with immunologic activation due to primary EBV infection. The patient was left untreated, under close observation. All clinical findings resolved within 3 mo and EBV viral capsid antigen (VCA) IgM antibodies converted to negative after 6 mo. A 3‐y follow‐up period was uneventful.
Neurological features in Gaucher's disease during enzyme replacement therapy
Authors: Ono H , Fujiwara M , Ito K , Ueda H , Mizoguchi N , Sakura N
Published: August 2010

This report describes two patients with Gaucher's disease who had unusual clinical symptoms during enzyme replacement therapy. One patient was a female with type 3 Gaucher's disease. She developed a pericardial effusion at 7 y of age, which contained many Gaucher cells despite enzyme replacement therapy. She died from neurological deterioration during enzyme replacement therapy, despite an improvement in her visceral manifestations. The other patient is a male with type 2 Gaucher's disease, who has achieved long‐term survival after being supported by mechanical ventilation and enzyme replacement therapy. While on enzyme replacement therapy at the age of 4y, he suffered a generalized cutaneous disease which was clinically diagnosed as ichthyosis.

Conclusion: These cases suggest that ordinary enzyme replacement therapy is insufficient for some of the non‐neurological manifestations of severe types of Gaucher's disease.
Guidelines for treatment of neonatal jaundice. Is there a place for evidence‐based medicine?
Authors: Hansen TWR
Published: August 2010

Treatment of neonatal jaundice continues to be a controversial issue. Arguments that traditional practice results in over‐treatment have led to the adoption of more liberal guidelines in some countries. The importation of liberal guidelines from one country to the next, however, is fraught with danger, because differences in epidemiology, sociology and healthcare delivery systems between countries may not be adequately reflected. The unreflected extension of liberalization to non‐target groups of patients can expose the latter to significant risk. It is not clear that the evidence on which guidelines for treatment of neonatal jaundice are based satisfy the requirements for evidence‐based medicine. Evidence of adequate quality may be hard to obtain.

Conclusions: Introduction of more liberal guidelines for the treatment of neonatal jaundice, if at all contemplated, must be adapted to local circumstances, and any available evidence pertaining to local epidemiology, sociology and healthcare organization has to be carefully weighed and incorporated. The time is ripe for a joint international effort to secure adequate funding for basic and applied research within the mechanisms of bilirubin encephalopathy in the newborn.
Two different doses of gluten show a dose‐dependent response of enteropathy but not of serological markers during gluten challenge in children with coeliac disease
Authors: Jansson UHG , Gudjónsdóttir AH , Ryd W , Kristiansson B
Published: August 2010

In order to study dose‐dependency in histopathological reactions and in changes of serological markers of mucosal relapse, gluten challenge was performed with two defined amounts of gluten in 54 children with earlier enteropathy. Gluten was provided in the form of powder and the patients were randomly allotted to either 0.2 (group A, n= 27) or 0.5 (group B, n= 27) grams per kg body weight per day. At the start and after 4 wk of challenge a small intestinal biopsy was performed. Biopsy specimens were evaluated, in accordance with defined criteria, graded and summarized in an enteropathy score. Blood was sampled at the start and after 2 and 4 wk of challenge. Serum levels of anti‐gliadin antibodies (AGA) and anti‐endomysium antibodies (EmA) were measured. Within 4 wk of challenge, 24 out of 27 patients in group A and all patients in group B had relapsed. After increasing the gluten dose to 0.5 g/kg/d during the subsequent 4 wk, the three non‐relapsing patients also relapsed.

Conclusion: The severity of mucosal inflammation was significantly higher for group B (p= 0.04) indicating a dose‐related severity of the enteropathy. No significant difference was found for maximum AGA level, or in the proportion of patients that converted to pathological values for AGA or EmA.
Inhalation of corticosteroids after hospital care for respiratory syncytial virus infection diminishes development of asthma in infants
Authors: Hesselmar B , Adolfsson S
Published: August 2010

The aim of the study was to assess the effect of inhaled corticosteroids on subsequent respiratory symptoms and asthma in infants hospitalized for respiratory syncytial virus infection (RSV). The study included 188 children below 12 mo of age, hospitalized because of RSV infection. During the winter of 1994/95 only selected children (13%) were given inhaled corticosteroids following discharge from the hospital. The following winter (1995/96), almost all children (86%) were given this treatment for 6–;8 wk. Outcomes of the two different treatment regimens were compared by questionnaire 19–;24 mo after discharge. Children hospitalized and treated during the winter of 1995/96 developed asthma (12% vs. 24%) and other severe symptoms of the respiratory tract less often than infants treated the year before. The frequency of children with less severe symptoms did not differ between the two treatment periods.

Conclusion: The results indicate that inhalation of corticosteroids for 6–;8 wk may reduce subsequent asthma and severe respiratory morbidity in infants hospitalized for RSV infection.
Changing panorama of cerebral palsy in Sweden. VIII. Prevalence and origin in the birth year period 1991–94
Authors: Hagberg B , Hagberg G , Beckung E , Uvebrant P
Published: August 2010

This 8th Swedish population‐based cerebral palsy (CP) report comprises 241 children born 1991–94. The live birth prevalence was 2.12 per 1000. Excluding 7 postnatally‐derived cases, the gestational age‐specific prevalences were 86 for extremely preterm children, 60 for very preterm and 6 for moderately preterm, and 1.3 for term children per 1000. Spastic hemiplegic, diplegic and tetraplegic subtypes accounted for 33%, 44% and 6%, dyskinetic CP for 12% and simple ataxia for 4%. Neuroimaging had been performed in 90%. Probable aetiology was identified in 73% of preterm and 86% of term children. Among preterm children it was considered prenatal in 12%, peri/neonatal in 61% and unclassifiable in 27%, while it was 51%, 36% and 14% among term children.

Conclusion: The live birth prevalence for CP in the birth year period 1991–94 continued to decrease slightly. Gestational age‐specific prevalences increased marginally in extremely and very preterm births, continued to decrease in moderately preterm births and decreased slightly in term births. Probable aetiology and timing of the brain insult could be revealed in 81%, birth asphyxia being the likely cause in 28% of term children.
Smoking related to plasma leptin concentration in pregnant women and their newborn infants
Authors: Helland IB , Reseland JE , Saugstad OD , Drevon CA
Published: August 2010

Leptin, a hormone produced in adipose tissue and placenta, is potentially important in relation to energy metabolism and growth. We investigated the effect of cigarette smoking on maternal plasma leptin concentration during pregnancy, and on plasma leptin concentration and weight among infants up to 13 wk of age. Plasma leptin concentration was measured in women in week 18 (n= 203) and week 35 (n=164) of pregnancy, while cotinine (nicotine metabolite) was measured in plasma sampled from mothers in week 35 of pregnancy (n= 159). Leptin concentration was also measured in plasma from the umbilical cord (n= 133) and from 4‐wk‐old (n= 129) and 13‐wk‐old (n= 130) infants. There was no difference in plasma leptin concentration between smoking and non‐smoking mothers at 18 wk and at 35 wk of pregnancy. Plasma cotinine concentration was higher in smoking than in non‐smoking mothers, and a negative correlation between plasma cotinine and leptin concentrations was found. The leptin concentrations in umbilical cord plasma were similar, although the birthweights of newborns from smoking mothers were significantly lower than those from non‐smoking mothers. The plasma leptin concentrations were similar between the two groups also at 4 wk of age. At 13 wk of age, infants of smoking mothers had significantly higher plasma leptin concentrations than infants of non‐smoking mothers.

Conclusion: Our results indicate that a lower birthweight of neonates among smoking mothers is not due to altered plasma leptin concentration.
Clinical predictors of outcome following mild and moderate neonatal encephalopathy in term newborns in Kathmandu, Nepal
Authors: Ellis M , Shrestha L , Shrestha PS , Manandhar DS , Bolam AJ , de L Costello AM
Published: August 2010

We describe a clinical grading system for the assessment of neonatal encephalopathy developed for a large prospective study in Kathmandu. Inter‐observer variability testing of our system on 27 infants showed high agreement (kappa value 0.87). Validity for the prediction of major neuro‐developmental impairment at 1 y of age was tested using a cohort of 57 survivors of encephalopathy, all of whom were assessed using a combination of the Denver Developmental Screening Test and Bailey 2 at 1 y. We compared this with a modification of a scoring system previously validated in Cape Town. Both schemes converted a pretest probability of 31% (the prevalence of major impairment at 1 y of age in this cohort) to a post‐test probability of 55%. This showed only marginal improvement over the traditional risk marker of neurological abnormality at discharge (post‐test probability 51%). At 6 wk of age acquired microcephaly increased the probability of major impairment to 79%.

Conclusions:It seems to make little difference both in practical or predictive terms whether one describes the neurological condition of the neonate using a descriptive or scoring system. The important thing is to perform repeated systematic neurological examinations on a daily basis during the neonatal period. Many clinicians will justifiably continue to use the discharge examination as the deciding factor for the need for continued neurodevelopmental surveillance.
Breastfeeding and complementary feeding practices in rural Malawi
Authors: Vaahtera M , Kulmala T , Hietanen A , Ndekha M , Cullinan T , Salin M‐L , Ashorn P
Published: August 2010

To facilitate optimal growth of newborns, many countries have developed infant feeding recommendations, usually suggesting 4–6 mo of exclusive breastfeeding and then the gradual introduction of complementary foods. We prospectively studied the changes in infant diets and predictors of adherence to national infant feeding recommendations in a cohort of 720 newborn babies in rural Malawi, Sub‐Saharan Africa. Monthly interviews of the main guardians indicated that breastfeeding was universal for 18 mo. As most babies were given water or other supplemental foods soon after birth, the exclusive breastfeeding rates were only 19%, 8%, 2% and 0% at ages 1, 2, 3 and 4 mo, respectively. Complementary foods and family foods were introduced at median ages of 2.5 and 6.3 mo, i.e. much earlier than recommended. Better adherence to recommendations was associated with smaller number of children in the family, increased maternal education and some other socio‐economic or environmental variables.

Conclusion: Exclusive breastfeeding is uncommon and complementary foods were introduced early to newborns among these rural families. Education and family planning may improve adherence to infant feeding recommendations and reduce the incidence of early childhood malnutrition in Malawi.
Correlation between level of self‐regulation in the newborn infant and developmental status at two years of age
Authors: Lundqvist‐Persson C
Published: August 2010

The purpose of this study was to investigate whether the level of self‐regulation in the newborn baby (a) predicts later cognitive and social development, (b) correlates to duration of breastfeeding and (c) has an impact on sleeping rhythm and the infant's autonomic behaviour. The study involved 38 full‐term infants of optimal health who were assessed at an age of 3 d using a screening instrument measuring neonatal self‐regulation, low, ordinary and high. The instrument, a conditional global scale, developed on the basis of the items in the Neonatal Behavioral Assessment Scale, identifies three levels of self‐regulation. Thirty‐six of the infants participated in a follow‐up study at 2 y of age, when they were tested with Griffiths' Mental Developmental Scales and one of the parents was interviewed about length of breastfeeding, sleeping habits and the infant's autonomic behaviour. The results showed that the level of self‐regulation was correlated to 3 out of 5 variables (Personal‐Social development, Hearing & Speech and Eye & Hand Coordination) in the Griffiths test. The results also indicated differences in sleeping rhythm as well as in breastfeeding patterns between the three groups. Furthermore, the study indicated gender‐based differences in the level of neonatal self‐regulation and confirmed previous findings of gender‐based differences in achieved developmental level at 2 y of age assessed with Griffths' Mental Developmental Scales.

Conclusion: The findings in this study indicate that infants with a low level of self‐regulation are at risk for poorer social and cognitive development as well as regulatory disorders.
Enterobacter sakazakii infection in the newborn
Authors: Bar‐Oz B , Preminger A , Peleg O , Block C , Arad I
Published: August 2010

Enterobacter sakazakii, a Gram‐negative bacillus, previously known as “yellow pigmented Enterobacter cloacae,” is a rare cause of neonatal infection. We describe the detailed clinical presentation of two cases in whom E. sakazakii was isolated in our neonatal service during the course of 1 mo. These include one case of sepsis and meningitis complicated by cerebral infarction, and one case of sepsis. In addition, three cases of intestinal colonization were identified. The source of the organism was thoroughly sought and was found to be a blender in the milk kitchen that was used for preparation of the reconstituted powdered milk formula.

Conclusion: Our paper adds clinical and laboratory information about the disease spectrum caused by this relatively rare organism and emphasizes the importance of a thorough search for the source of the infection.
Role of natriuretic hormones in the diagnosis of patent ductus arteriosus in newborn infants
Authors: Pesonen E
Published: August 2010

Haemodynamically significant patent ductus arteriosus worsens respiratory distress by initiating pulmonary congestion and inactivating of surfactant. Excepting size of the ductus, several factors influence ductal flow.

Conclusion: Atrial natriuretic hormones provide clinically useful data, especially in serial follow‐up of the patient.
Parents' observations of sexual behaviour in pre‐school children
Authors: Lagerberg D
Published: August 2010

This commentary on the Larsson and Svedin study of sexual behaviour in pre‐school children, published in the present issue of Acta Paediatrica (1), centres around three questions: 1. How can normal sexual behaviour in children be distinguished from problematic behaviour? 2. What characterizes the sexual development of the normal child? 3. Can knowledge about normal and problematic sexual behaviour be used to screen for sexual abuse or to confirm cases of sexual victimization? It is recommended that the inventory used by the authors be standardized on a representative sample of Swedish children, because this would enhance its usefulness in distinguishing normal from problematic behaviour. It is further recommended that research about sexual development in children be based on person‐oriented rather than on variable‐oriented analyses. It is finally argued that knowledge about normal and problematic sexual behaviour may not contribute to more effective screening or confirmation procedures in suspicions of sexual abuse. However, knowledge about normal sexual behaviour is valuable in studies of sexual behaviour in different categories of children, e.g. in the developmentally delayed or psychosocially deprived.

Conclusion: By helping to identify problematic sexual behaviour in individual children, a standardized inventory could guide professionals in detecting possible psychological problems accompanying the behaviour.
Breast odour as the only maternal stimulus elicits crawling towards the odour source
Authors: Varendi H , Porter RH
Published: August 2010

In previous studies, newborn infants placed on their mother's chest grasped a nipple and sucked without assistance. Furthermore, neonates sucked preferentially from an untreated breast rather than the alternative breast that had been washed to eliminate its natural odour. This study investigated the influence of breast odours per se on orientated physical movement of neonates. In total, 22 babies were observed during two trials on a warming bed. In one trial, a pad carrying the mother's breast odour was placed 17 cm in front of the baby's nose; in the other trial a clean pad was used. More babies moved towards and reached the breast pad than the clean pad.

Conclusion: Natural breast odours unsupported by other maternal stimuli therefore appear to be sufficient to attract and guide neonates to the odour source.
Body mass index, triceps skinfold and waist circumference in screening for adiposity in male children and adolescents
Authors: Sarría A , Moreno LA , Garcí‐LIop LA , Fleta J , Morellón MP , Bueno M
Published: August 2010

Simple anthropometric measurements and indices are the most commonly used tools for assessing body composition. Only a few papers have examined the sensitivity and specificity of the body mass index (BMI) against total body fat percentage (TBF%) from underwater weighing in children and adolescents. The objective of the study was to evaluate the screening performance of BMI, triceps skinfold thickness and waist circumference for excess TBF%. A total of 175 healthy volunteer males, aged 7.0–16.9 y, participated in the study. TBF% was measured using underwater weighing as the reference method. Receiver operating characteristic (ROC) curves were constructed to assess the value of the three anthropometric measurements as a screening measure for total adiposity. Sensitivity and specificity were calculated at several percentile cut‐offs for BMI, triceps skinfold and waist circumference. The areas under the ROC curves were also calculated, and were 0.86 for BMI, 0.90 for triceps skinfold and 0.88 for waist circumference. The point on the ROC curve closest to 1 corresponded to the 70th percentile for BMI, to the 75th percentile for triceps skinfold, and to the 70th percentile for waist circumference.

Conclusion: BMI, triceps skinfold and waist circumference predicted total fat content well in male children and adolescents.
Current diagnosis, management and morbidity in paediatric inflammatory bowel disease
Authors: Spray C , Debelle GD , Murphy MS
Published: August 2010

In the 1970s several reports highlighted the long delay in diagnosis often experienced by children with Crohn's disease. In recent years this disorder has attracted much publicity, and many believe that the incidence has increased substantially. The aim of this investigation was to determine whether heightened awareness had shortened the interval to diagnosis, improved clinical management and reduced morbidity. A retrospective study was therefore carried out on 112 children with inflammatory bowel disease (64 Crohn's disease, 41 ulcerative colitis, 7 indeterminate colitis) referred to a paediatric gastroenterology department in the UK between 1994 and 1998. In Crohn's disease the median interval to diagnosis was 47 wk (maximum 7 y). In those without diarrhoea this was longer (66 vs 28 wk; p= 0.005). In ulcerative colitis the median interval was 20 wk (maximum 3 y). Even in severe colitis the median interval was 5.5 wk (range 3–9 wk) and 4 required urgent colectomy soon after referral. Many with unrecognized Crohn's disease had undergone inappropriate treatments, such as growth hormone or psychiatric therapy. Nineteen (17%) had undergone endoscopic investigations in adult units prior to referral. Malnutrition was equally common in Crohn's disease and ulcerative colitis (11%). Short stature was present in 19% with Crohn's disease, and 5% with ulcerative colitis, and was severe in 8% with Crohn's disease. There was a significant correlation between symptom duration and the degree of growth impairment present (rs= 0.4; p= 0.004).

Conclusion: This study suggests that late diagnosis and inappropriate investigation and management are still significant problems.
Rare alpha‐1‐antitrypsin phenotypes and liver‐test abnormalities during infancy
Authors: Pittschieler K
Published: August 2010

Over 14 y of neonatal screening 71675 dried blood samples were examined for the alpha‐1‐antitrypsin (α1‐AT) alleles by isoelectric focusing in the Province of Bozen, Northern Italy. In infants carrying abnormal phenotypes the liver enzymes alanine aminotransferase and gamma‐glutamyltransferase were determined at 2, 5 and 12 mo of age. In 17 neonates the PiMV phenotype was found, in 11 PiMF, in 11 PiMP, in 5 PiMN, in 3 PiMR, in 3 PiFZ, in 2 PiPZ and in 1 the PiMG phenotype was found. Two infants, 1 carrying the PiMV and 1 the PiFZ phenotype showed at the age of 2 and 5 mo, respectively, elevated values of the liver enzyme S‐ALAT[CE1]. Only the PiFZ and PiPZ carriers displayed low enough levels of α1‐AT of 0.78 and 0.85 g 1‐1, respectively, to be at moderately increased risk of pulmonary emphysema. Their early detection through the screening should discourage them from dangerous smoking habits.

Conclusion: Only a neonatal screening based on phenotyping can detect these rare carriers early in life.
Meconium passage in extremely low birthweight infants and its relation to very early enteral nutrition
Authors: Mihatsch WA , Franz AR , Lindner W , Pohlandt F
Published: August 2010

The aim of this study was to evaluate the correlation between the timing of the first and last meconium and feeding tolerance in the very early enteral nutrition of extremely low birthweight (ELBW) infants. Forty‐one ELBW infants were fed following a standardized protocol (day 3–14). At 48 h of age bolus gavage feeding with milk was started (12 ml kg‐1 d‐1 increments, 12 meals per day). Gastric residuals up to 2 ml or up to 3 ml were tolerated in infants with a birthweight of ± 750 g or ± 750 g, respectively. No enemas or laxatives were given during the study. The impact of the time until the passage of the first (M‐1) and last (M‐last) meconium on the feeding volume on day 14 (V14) was evaluated by linear regression analysis. Data are presented as median (range). M‐1 was 31 h (0.5–77 h), M‐last was 6d (1.4–22 d) and V14 was 99 (0–156) ml kg‐1. V14 increased with decreasing M‐last (p < 0.001) but there was no correlation between V14 and M‐1. V14 was 112 (0–156) ml kg‐1 if M‐last was shorter than 6 d and 37 (0–147) ml kg‐1 if M‐last was longer than 6 d.

Conclusion: Rapid meconium evacuation appeared to be a key factor for the feeding tolerance of ELBW infants during the first 14 d of life Further studies are needed to investigate whether meconium passage can be accelerated and whether acceleration of the meconium passage will improve the early feeding tolerance in ELBW infants.
Sexual behaviour in Swedish preschool children, as observed by their parents
Authors: Larsson I , Svedin C‐G
Published: August 2010

Issues of what constitutes normal and healthy childhood sexual behaviour have acquired new implications in the light of child sexual abuse. Increased knowledge in this area is therefore of vital importance and studies in different countries are needed. In the present study parents of 231 children aged 3–6 y were asked to answer questionnaires about their child's behaviour at home. The questionnaire consisted of four sections: demographic data, a general behaviour checklist, a sexual behaviour inventory, and attitudinal questions to the parents. The results showed that children in Sweden exhibit a wide range of sexual behaviour, most of them developmentally related. Some behaviour appeared to be very rare in a normative sample of preschool children and included behaviours usually referred to as sexualized and problematic. Reports on sexual behaviour in the children were also related to general behaviour reports, the parent's socio‐economic level, parental attitudes towards child sexuality and the openness of family habits.

Conclusion: There is a need for further national studies in different settings, to help create a better understanding of what constitutes both normative and deviant sexual behaviour in children.
Reactive thrombocytosis in children with upper urinary tract infections
Authors: Garoufi A , Voutsioti K , Tsapra H , Karpathios Th , Zeis PM
Published: August 2010

The relationship between reactive thrombocytosis and the level of urinary tract infections was studied in 48 children. Platelets were counted before, during and after treatment. Reactive thrombocytosis was noticed in 74% of children with upper and in 14% with lower urinary tract infections. A significant rise in the platelet count presented in another five children (15%) with upper urinary tract infections.

Conclusion: Reactive thrombocytosis was found almost exclusively in the renal parenchymal infections, usually during the recovery phase.
High proportions of n‐6 polyunsaturated fatty acids in mature milk of mothers in Ouagadougou, Burkina Faso
Authors: Rocquelin G , Kiffer J , Tapsoba S , Bouda C
Published: August 2010

Milk from 101 mothers living in Ouagadougou (Burkina Faso) showed a mean lipid content of 33.42 g/l and a fatty acid composition strongly related to the mothers' dietary habits: high proportions of linoleic acid (19.80%), n‐6 long‐chain polyunsaturated fatty acids (1.90%), and 8:0– 14:0 saturated fatty acids (26.94%).

Conclusion: The proportions of α‐linolenic acid (0.45%) and n‐3 long‐chain polyunsaturated fatty acids (0.44%) were low. The 18:2 /18:3 and n‐6/n‐3 long‐chain polyunsaturated fatty acids ratios (53:1 and 5:1, respectively) were well above recommendations.
Fertility in Prader‐Willi syndrome: a case report with Angelman syndrome in the offspring
Authors: Schulze A , Mogensen H , Hamborg‐Petersen B , Græm N , Østergaard JR , Brøndum‐Nielsen K
Published: August 2010

We report on a 32‐y‐old woman with Prader‐Willi syndrome (PWS) and her daughter with Angelman syndrome (AS). PWS in the mother was confirmed as due to a deletion of 15q11‐q13, and molecular analysis in the neonate indicated an inherited maternal deletion of the same region. Features of AS in early infancy, such as jerky movements, feeding problems and poor sleep, were observed. At 5 mo of age, a triphasic high voltage EEG pattern was reported.

Conclusions: This case confirms the non‐Mendelian inheritance of PWS and AS and, in addition to previous reports, provides evidence of fertility in PWS women. We recommend the provision of information regarding fertility in females with PWS to parents, guardians and individuals with PWS, and frequent EEG monitoring for early AS diagnosis. Given the different genetic aetiologies for PWS and AS, cytogenetic and molecular genetic analysis is strongly indicated for counselling and risk estimation.
Long chain polyunsaturated fatty acids (LC‐PUFA) and perinatal development
Authors: Koletzko B , Agostoni C , Carlson SE , Clandinin T , Hornstra G , Neuringer M , Uauy R , Yamashiro Y , Willatts P
Published: August 2010

This paper reports on the conclusions of a workshop on the role of long chain polyunsaturated fatty acids (LC‐PUFA) in maternal and child health The attending investigators involved in the majority of randomized trials examining LC‐PUFA status and functional outcomes summarize the current knowledge in the field and make recommendations for dietary practice. Only studies published in full or in abstract form were used as our working knowledge base.

Conclusions: For healthy infants we recommend and strongly support breastfeeding as the preferred method of feeding, which supplies preformed LC‐PUFA. Infant formulas for term infants should contain at least 0.2% of total fatty acids as docosahexaenoic acid (DHA) and 0.35% as arachidonic acid (AA). Since preterm infants are born with much less total body DHA and AA, we suggest that preterm infant formulas should include at least 0.35% DHA and 0.4% AA. Higher levels might confer additional benefits and should be further investigated because optimal dietary intakes for term and preterm infants remain to be defined. For pregnant and lactating women we consider it premature to recommend specific LC‐PUFA intakes. However, it seems prudent for pregnant and lactating women to include some food sources of DHA in their diet in view of their assumed increase in LC‐PUFA demand and the relationship between maternal and foetal DHA status.
Prevention of pneumococcal disease in children. Pneumococcal conjugate vaccines: their use globally could have a major impact on public health
Authors: Kyaw MH , Jones IG , Campbell H
Published: August 2010

Pneumococcal disease is a major cause of morbidity and mortality in infants and young children worldwide. New pneumococcal conjugate vaccines include 7 to 11 serotypes, which are the most common cause of paediatric disease in most parts of the world. The efficacy of a 7‐valent conjugate vaccine was 97.4% (95% CI, 82.7–99.9) against invasive pneumococcal disease, and 57% (95% CI, 44–67) against otitis media, caused by vaccine serotypes. Evidence shows that the vaccine has the potential to prevent pneumonia. Pneumococcal conjugate vaccination has also been shown to reduce nasopharyngeal carriage of vaccine serotypes (particularly serotypes associated with antibiotic resistance). Thus widespread use of pneumococcal conjugate vaccine could substantially reduce the burden of invasive disease and would have the potential to control the global spread of antibiotic resistance in pneumococci.

Conclusion: It is important that these highly effective vaccines should be made available to children in the developing countries.
Intestinal permeability in children: variation with age and reliability in the diagnosis of cow's milk allergy
Authors: Kalach N , Rocchiccioli F , de Boissieu D , Benhamou P‐H , Dupont C
Published: August 2010

Objective:To analyse to what extent age may alter intestinal permeability (IP) in children and to assess its reliability according to clinical manifestations in cow's milk allergy (CMA).Design: A routine prospective study was performed in 200 children (12.5 ±23 mo, 0.5–168 mo) presenting with clinical manifestations suggesting CMA. Controls (n= 105) were those with a negative cow's milk challenge, whereas CMA children (n= 95) fulfilled ESPGHAN criteria. Permeability was measured as a percentage of urinary excretion of lactitol (L, %) and mannitol (M, %) (0.1 g/kg for each, oral absorption after a 6h fast, 5 h urine collection, analysis by gas chromatography) and determination of the L/M ratio (L/M, %).Results:In control children, L/M correlated negatively with age (r−0.33,p =0.0006), whereas in those with CMA no correlation was found. Median L/M was significantly higher in CMA children (n= 95) than in controls (n= 105), 4.35 ± 7.57% (95% CI 5.30–8.39%) vs 1.97 ±0.87% (95% CI 1.76–2.09%), (p= 0.0001). With a L/M cut‐off value defined as mean + 2 SD of controls, in CMA IP exhibited a 68% sensitivity and a 77% negative predictive value. The highest sensitivity (70%) was seen at ages 6–12 mo and the lowest (58%) at age more than 3 y. An abnormal IP was seen in 80% of CMA children with digestive manifestations, in 43% with extra‐digestive, 68% with mixed and 40% with anaphylactic manifestations.

Conclusion:IP correlates negatively with age in control children and is altered in children with CMA. The test is at its most accurate in the diagnosis of CMA when done at ages 6–12 mo, when there are digestive manifestations.
Efficacy of a packaged rice oral rehydration solution among children with cholera and cholera‐like illness
Authors: Zaman K. , Yunus M , Rahman A. , Chowdhury HR , Sack DA
Published: August 2010

In past studies, patients with cholera and cholera‐like diarrhoea treated with rice oral rehydration solution (ORS) had lower purging rates and a shorter illness duration. We evaluated a new packet form of rice ORS (CeraLyte‐90) in 167 boys aged 5 to 15 y, with acute, dehydrating cholera and cholera‐like diarrhoea in Bangladesh. The patients were randomized to receive either CeraLyte‐90 (n= 85) or glucose ORS (n= 82) and were given early feeding and early antibiotics. The efficacy of the two solutions was compared for stool output during the first 8 h, the first 24 h, and total output, duration of diarrhoea, hematocrit, serum electrolytes and requirement for unscheduled intravenous fluids. The clinical and laboratory characteristics of the two groups were comparable on admission, and most of the patients had cholera (88% and 84% in the CeraLyte and glucose groups, respectively). The mean (± SE) stool output was 20% less in the rice ORS group during the first 8 h of treatment (86.2 ± 6.6 ml/Kg vs 108 8 ± 7.9 ml/Kg, p < 0.05), but the outputs during the other time periods were similar in the two groups, although children in the rice ORS group had slightly more vomiting on day one (p < 0.05). The mean serum electrolyte concentrations in both groups of children remained within normal range.

Conclusion: The study documents the safety and efficacy of the new, packaged rice ORS.