bluuebunny/crossref_metadata_2025 huggingface dataset:
Free‐radical‐induced lipid peroxidation during the early neonatal period
Authors: Varsila Eeva , Hallman Mikko , Andersson Sture
Published: January 2008

The effect of gestational age on postnatal free‐radical‐mediated lipid peroxidation was studied in 19 term (gestational age 37–42 weeks) and 21 healthy preterm (gestational age 31–36 weeks) infants by measurement of expired ethane and pentane during the first 7 days of life. Ethane (11.9 versus 5.7 pmol/kg/min; p= 0.0001) and pentane (11.4 versus 7.5 pmol/kg/min; p= 0.01) were significantly higher in preterm than in term infants. Correlations were found between gestational age and ethane (r= 0.60, p= 0.0001) for days 1–7 and pentane (r= 0.54, p= 0.0003) for days 3–7; and between birth weight and ethane (r= 0.58, p= 0.0001) and pentane (r = 0.55, p= 0.0003). These results indicate that during the postnatal period, immaturity is a major factor determining the rate of free‐radial‐mediated lipid peroxidation.
Diagnostic value of plasma levels of tumor necrosis factor α (TNFα) and interleukin‐6 (IL‐6) in newborns with sepsis
Authors: de Bont ESJM , Martens A , van Raan J , Samson G , Fetter WPF , Okken A , de Leij LHFM , Kimpen JLL
Published: January 2008

The aim of this study was to examine if TNFα and IL‐6 plasma levels could be of value in diagnosing neonatal sepsis. Tumor necrosis factor α (TNFα) and interleukin‐6 (IL‐6) plasma levels were determined in 15 newborn infants with confirmed sepsis (group I), 18 with suspected sepsis (group II) and 22 control infants (group III). In 33 newborns, initially suspected of having sepsis (groups I and 11), a positive test result for plasma concentration of TNFα (> 70 pg/ml) had a sensitivity of 73 % and a specificity of 94%. A positive test result for IL‐6 (>500 pg/ml) had a sensitivity of 80% and a specificity of 78%. When plasma levels of TNFα and IL‐6 were combined for the diagnosis of neonatal sepsis, a positive test result for both tests had a sensitivity of 60% and a specificity of 100%. When both tests are positive the diagnosis of neonatal sepsis is almost certain (likelihood ratio =α. The combination of TNFα and IL‐6 determinations appears to be a good predictor of neonatal sepsis.
Autologous cord blood transfusion
Authors: Ballin A , Kenet G , Gutman R , Samra Z , Zakut H , Meytes D
Published: January 2008

Newborn piglets were exsanguinated (60% of blood volume) and retransfused 1 h later. One test group received adult pig red blood cells, the other piglet cord blood cells; controls were infused with plasma. While all controls died, satisfactory results were achieved in piglets transfused with either adult or foetal blood. The feasibility of collecting human cord blood for transfusion was assessed in 100 samples of human cord blood. Blood was collected aseptically and aerobic and anaerobic cultures set up. All samples of cord blood were sterile, and all wereMycoplasmanegative. Coagulation parameters were analysed in eight cord plasma samples stored at −20 °C for 45 days. No significant abnormalities were found immediately after birth or after storage
Pulsatile growth pattern during catch‐up growth in childhood coeliac disease
Authors: Greco L , Tipo V , Di Donato F , Mayer M
Published: January 2008

Catch‐up growth in coeliac disease was thought to be a continuous process and hence linear models have been proposed to interpret the pattern of catch‐up growth. Observed longitudinal data do not fit a linear model adequately. The aim of this study is to clarify the pattern of short‐term catch‐up growth in coeliac patients. Twenty‐one coeliac children (aged 6–24 months) entered the study and were monitored at short‐time intervals. All showed a “pulsatile” pattern of growth velocity for height, weight, leg length, subscapular and triceps skinfolds. Peaks alternated with troughs at a mean time of 62 days for the whole set of measurements. The periodicity was remarkably stable. The size of the peaks decreased with time on a gluten‐free diet. Catch‐up growth is a discontinuous process made up of a sequence of bursts of growth followed by a resting phase. This provides strong evidence for the possibility that short‐term growth may be pulsatile.
Predictors of outcome of stroke in infants and children based on clinical data and radiologic correlates
Authors: Keidan Ilan , Shahar Eli , Barzilay Zohar , Passwell Justen , Brand Natan
Published: January 2008

Outcome predictors were analyzed in 45 infants and children with cerebrovascular disorders (CVD), based on clinical features and radiological correlates. The clinical features at presentation could be categorized into three major groups: (1) generalized: alteration of consciousness with or without seizures—24 patients (54%); (2) focal: acute hemiplegia or monoplegia with or without focal seizures—18 patients (40%); (3) cerebellar disturbances—3 patients (6%). The underlying etiology was detected in 80% of children. Thirty‐seven patients (82%) survived the initial debilitating event, of whom 11 (29.7%) recovered completely and the rest had either motor or cognitive handicaps during an average follow‐up period of 4.2 years (range 1.5–11 years). A head CT performed in all children revealed ischemic infarction in 29 patients (64.4%), while the others had hemorrhagic infarction. Of those with an initial generalized neurological presentation, as many as 50% had multi‐focal lesions on CT. All children with focal neurological findings had a solitary localized lesion on CT, mainly in the distribution of the middle cerebral artery. Statistical analysis for outcome prediction showed that the following variables were associated with increased risk of immediate death: (1) hemorrhagic infarction demonstrated by brain CT (p= 0.031); (2) patients who presented with a generalized neurological disorder, namely alteration of consciousness, with or without seizures (p= 0.036). No other clinical or laboratory variables were predictive of imminent death, motor or cognitive handicaps. These may therefore serve as outcome predictors of stroke in the pediatric age group.
Agenesis of pancreas
Authors: Voldsgaard P , Kryger‐Baggesen N , Lisse I
Published: January 2008

Complete agenesis of pancreas is a rare and lethal condition. Four cases have previously been reported in combination with other malformations, such as severe intrauterine growth retardation, hyperglycaemia and meconium ileus. We report a case of pancreatic agenesis as a single anomaly. The child died when 48 h old with severe metabolic acidosis. The literature is surveyed and the pathogenesis is discussed.
Respiratory water loss and oxygen consumption in full‐term infants exposed to cold air on the first day after birth
Authors: Sjörs G , Hammarlund K , Kjartansson S , Riesenfeld T , Sedin G
Published: January 2008

Respiratory water loss, oxygen consumption, carbon dioxide production and skin blood flow were measured continuously in nine full‐term infants on the first day after birth. After at least 18 min of measurements with the infant asleep in an incubator, with an air temperature of 33°C and a relative humidity of 50%, the temperature of the incubator air was lowered to less than 27.5°C. This resulted in a significant decrease in skin temperature and peripheral skin blood flow, while the infant's core temperature remained unchanged. At the same time, mean respiratory water loss increased from 3.7 to 6.1 mg/kg‐min, which can be explained partially by the decrease in ambient humidity that accompanied the decrease in air temperature. In addition, mean oxygen consumption increased from 5.3 to 7.9 ml/kg. min and mean carbon dioxide production increased from 3.8 to 5.9 ml/kg‐min. There was no concomitant increase in motor activity. Thus, when the newborn infants were exposed to cool air, they reacted with an increase in respiratory water loss, oxygen consumption and carbon dioxide production before their core temperature was affected and without increasing their motor activity.
Age and gender specific serum lipid and apolipoprotein fractiles of Finnish children and young adults. The Cardiovascular Risk in Young Finns Study
Authors: Porkka KVK , Viikari JSA , Rönnemaa T , Marniemi J , Åkerblom HK
Published: January 2008

We present fractile data on serum lipids and apolipoprotejns A‐1 and B for children and young adults from the cardiovascular risk in young Finns study cohort of 1986. The sample comprised 2370 fasting children and young adults (1114 males and 1256 females) aged 9, 12, 15, 18, 21 and 24 years. The determinations were performed in duplicate with standard methods. LDL‐cholesterol values were calculated. The limits for clearly pathological values (exceeding the 97.5th percentile) irrespective of age and gender were 7.5 mmol/l, 5.0 mmol/l, 3.5 mmol/l and 1.4 g/1 for serum total cholesterol, LDL‐cholesterol, triglycerides and apolipoprotein B, respectively. Corresponding values (below the 2.5th percentile) for HDL‐cholesterol, apolipoprotein A‐1, HDL2‐‐ and HDL3‐cholesterol were 0.80 mmol/l, 1.0 mg/l, 0.20 mmol/l and 0.70 mmol/l, respectively. Approximately 79%, 33% and 7% of males had serum total cholesterol values greater than 4.0 mmol, 5.0 mmol/l and 6.0 mmol/l, respectively. Corresponding percentages for females were 87%, 43% and 10%. However, age‐related differences were marked. The prevalence of values, e.g. greater than 6 mmol/l according to age, ranged from 6 to 13% in females and from 3 to 12% in males, emphasizing the need for age‐specific reference values. Additionally, postpubertal values for total and LDL‐cholesterol tended to be slightly lower compared to prepubertal values, indicating that the reference values for adults do not apply to adolescents and young adults. The age‐related changes in lipid levels were evident in each fractile and were especially accentuated in higher fractiles. Fluctuations with age were more pronounced in males than in females. These results are intended to be applied as reference values for diagnosing dyslipidemias.
Salmonella enteritidis orchitis in a 10–week‐old boy
Authors: Berner R , Schumacher RF , Zimmerhackl LB , Frankenschmidt A , Brandis M
Published: January 2008

Extraintestinal manifestations of salmonellosis in paediatric patients are found predominantly in infants less than three months of age. Genital involvement is a rare complication. We present a short review of the literature and describe the case of a 10–week‐old boy suffering from severe diarrhoea, who presented with a swelling of the right testicle after six days of illness. He underwent surgery on suspicion of testicular torsion, whereby orchitis was diagnosed. Salmonella enteritidis was cultured from the intraoperative swab. All cultures from blood, CSF and urine remained sterile. We conclude that orchitis must be taken into consideration as an extraintestinal complication of enteric salmonellosis and as a differential diagnosis of tcsticular torsion. In addition, we wish to emphasize that any infant less than three months of age with suspected or proven salmonellosis, should receive early antibiotic treatment.
The screening programme for congenital hypothyroidism in Greece: evidence of iodine deficiency in some areas of the country
Authors: Mengreli C , Yiannakou L , Pantelakis S
Published: January 2008

Newborn screening for Congenital Hypothyroidism, using TSH measurement in dried blood spots, was started in Greece in 1979. A total of 1,274,000 neonates have been screened and 377 cases of Congenital Hypothyroidism were detected, for an incidence of 1:3370. Employing a cut‐off point of 30mU/L of TSH in whole blood, 0.3% of the infants were recalled for repeat examination. The sensitivity of the screening test was 0.99 and the predictive value of a positive test 0.1. The frequency of “false positive” cases in the different geographic regions of Greece showed wide variation between the south and the north areas of the country. We suggest that these differences reflect the degree of iodine deficiency in the population and may be used as an epidemiological indicator of this deficiency.
Changing clinical features of coeliac disease
Authors: Visakorpi Jarmo K , Mäki Markku
Published: January 2008

The classical clinical picture of coeliac disease includes prolonged diarrhoea with failure to thrive. During the past two decades this type of active presentation of coeliac disease has decreased in many European countries, giving the impression that coeliac disease is a disappearing disease. However, this is not true. The disease can be found in older children with a more or less silent presentation. Silent coeliac disease can be detected by active screening with serological tests. Coeliac disease can be suspected in children suffering from mild gastrointestinal symptoms, such as abdominal pain, and in those with signs of nutritional deficiencies, as well as in children of first‐degree relatives of already diagnosed coeliacs, patients with IgA‐deficiency, patients suffering from dental enamel hypoplasia or dermatitis herpetiformis, and patients with some other disease known to be associated with coeliac disease, such as diabetes mellitus. According to the fundamental criteria of coeliac disease, the intestinal mucosa is flat when the individual is eating gluten‐containing foods. However, this is not strictly true. Intolerance to gluten is obviously variable and the intestinal mucosa may be normal. This type of latent coeliac disease can be detected by analysing genetic markers, measuring antibodies in intestinal fluid or counting the density of intra‐epithelial gamma/delta T cells which are increased greatly even in the latent phase of coeliac disease. Thus the general concept of the natural history of coeliac disease is changing.
Diagnosis and treatment of necrotizing enterocolitis. A retrospective evaluation of abdominal paracentesis and continuous postoperative lavage
Authors: Limmer J , Gortner L , Kelsch G , Schütze F , Berger D
Published: January 2008

From 1980 to 1991, 70 preterm and 20 term infants suffering from necrotizing enterocolitis (NEC) were treated at the University of Ulm hospitals. NEC was primarily suspected from clinical signs. The diagnosis was established by plain abdominal X‐rays, infection markers and abdominal paracentesis. Indication for surgery resulted from paracentesis, from radiologically proven perforation, from ileus symptoms and from rapid clinical deterioration; 44 preterm and 7 term infants underwent surgery. Bowel resections were performed in 5 of the term and in 16 of the preterm infants. An enterostomy was fashioned in 33 cases. Total necrosis of the gut was apparent in 8 infants. A continuous peritoneal lavage was performed in 34 babies. One term and 18 preterm babies, all with a birth weight less than 1000 g, died. This results in a NEC‐related overall mortality of 19%.
Neonatal necrotizing enterocolitis: a retrospective and multicentric review of 331 cases
Authors: Lemelle JL , Schmitt M , de Miscault G , Vert P , Hascoet JM
Published: January 2008

The authors retrospectively review 331 cases of necrotizing enterocolitis from 13 different departments of pediatric surgery; 184 cases were treated only medically at the acute stage (47 of whom developed intestinal stricture) and 147 cases were operated on at the acute stage. The different procedures of acute surgical intervention are reported and the results of two surgical procedures are compared. The first is a classical one comprising a laparotomy with exploration of the intestinal tract and resection of the necrotic segments followed by enterostomy above the resected area. The other procedure comprises a minimal laparotomy in the right lower quadrant with ileostomy above necrotic areas, without resection of necrotic segments associated with peritoneal drainage. The results are assessed using the postoperative mortality rate and the number of secondary intestinal strictures. Mortality during the first postoperative month occurred in 27.9% of cases, and intestinal strictures were noted in 31.3% of cases after acute surgical procedure.
Maternal cocaine abuse resulting in necrotizing enterocolitis‐an experimental study in a rat model
Authors: Büyükünal C , Kiliç N , Dervişoǧlu S , Altuǧ T
Published: January 2008

The aim of this study was to assess the relation between the use of cocaine during pregnancy and development of necrotizing enterocolitis in a rat model. Different doses of cocaine HC1 were given to pregnant Wistar Albino rats during gestation. Total number of live births, mean birth weight, mean placental weight and histopathological examination of the maternal uterus, placenta, embryonal G‐I tract and liver were investigated. These results were compared with a control group and showed that the number of live births, mean birth weight and mean placental weight were lower than in non‐cocaine controls. Histopathologic examinations revealed severe inflammation and vascular changes in the uterus and placenta. We also observed focal necrosis, necrobiosis, cellular debris, haemorrhage, inflammatory reactions in the G‐I tract of embryos. These findings indicate that maternal cocaine abuse should probably be considered a major risk factor for development of NEC in baby rats and embryos.
Tropical enterocolitis in children
Authors: Kapur VK , Subramaniam R
Published: January 2008

Besides classical necrotizing enterocolitis (in neonates), which is seen in India as elsewhere in the world, we observe sporadic cases of tropical enterocolitis, i.e. segmental jejunitis, ileitis or colitis and rarely duodenitis. This is a distinct clinico‐pathological entity presenting as “acute abdomen”, with pain, bilious vomiting, constipation or bloody diarrhoea. The clinical course is not as fulminating as neonatal necrotizing enterocolitis. Most cases are salvaged by conservative treatment especially after the confidence brought by laparoscopic vision of the abdomen, thus excluding perforation or gangrene of the bowel involved. Without laparoscopy, most of the cases end up in laparotomy. The pathology appears to be a kind of local hyperimmune reaction in the segment of bowel involved, ranging from punctate haemorrhages in the seromuscular layer of the bowel to a generalized red fiery look or perforation due to mucosal ulceration. Whatever the causative agent, the pathogenesis is of local vasculitis leading to ischemia and various patterns of disease.
Psychobiology of maternal behavior: contribution to the clinical understanding of maternal behavior among humans
Authors: Rosenblatt JS
Published: January 2008

Psychobiological studies of maternal behavior among non‐primate mammals have arrived at several general conclusions that may aid in our understanding of human maternal behavior and in the clinical treatment of parenting disorders. The hormonal basis of maternal behavior arises during pregnancy and consists of a hormonal priming phase, extending over most of pregnancy, and a hormonal triggering phase at the end of pregnancy. Hormonal priming in several species depends upon estrogen, progesterone and prolactin, and hormonal triggering depends upon a decline in progesterone and an increase in estrogen, prolactin and oxytocin in different species. The onset of maternal behavior is hormonally based but postpartum maternal behavior in several species is based upon the stimulation that the mother receives from her young (i.e. is non‐hormonally based). There is a transition period between these two phases soon after parturition during which contact with the young plays a crucial role in the maintenance of maternal behavior. The onset of maternal behavior may be viewed as the resolution of conflict between approach and withdrawal responses of females to their offspring.
Influences of environmental demand on maternal behavior and infant development
Authors: Rosenblum Leonard A , Andrews Michael W
Published: January 2008

Research has shown that in conjunction with genetic factors, significant aspects of non‐human primate development are influenced by the infant's physical and social environment. In addition to the direct impact of the environment on the infant, the infant's attachment relationship with the mother is seen as the primary mediating factor in shaping these influences. When the mother is able to cope with environmental demands, as a reflection of her responsivity to her infant's needs, she may prepare infants for periodic interuptions in her attention, ameliorate distress during disruptive periods and, most importantly, compensate for these disruptions with enhanced attention to her infant once they are ended. Our recent work shows that when the mother's survival requirements increase, and her coping capacities are exceeded, both short and long‐term deleterious effects on her developing offspring may emerge. Particularly when confronted with an unpredictable environment, mothers are less able to maintain effective, stress‐buffering, maternal‐coping mechanisms which can preserve a stable attachment relationship and permit normal infant development. When these coping mechanisms are insufficient, infants may show manifest disturbances, such as depression, during development or reveal more latent disturbances, such as reduced sociability and timidity, when psychologically challenged, even as young adults. Evidence now suggests that these long‐term effects may, at least in part, be the product of altered neurodevelopment of the serotonergic and noradrenergic systems.
The role of mother's voice in the organization of brain function in the newborn
Authors: Fifer WP , Moon CM
Published: January 2008

Newborn infants prefer the sound of the maternal voice within the first two days after birth. This early preference may be based on prenatal experience. The mother's voice is reported to be the most intense acoustical signal measured in the amniotic environment. Data showing the ability of the newborn to demonstrate voice preferences are presented. We have also investigated the response of the perinatal autonomic nervous system to speech sound stimulation. Both the newborn and fetus show heart rate decelerations in response to speech sounds. This cardiorespiratory attentional response occurs during sleep when sensory stimulation is probably influencing perinatal brain development. Early experience with voice has both acute and enduring effects on the developing brain. These effects have ramifications for the development of the auditory system, as well as for later social and emotional development. Further speculation and discussion on the form, function and assessment of newborn responsiveness to voice will be offered.
Natural growth in children born small for gestational age with and without catch‐up growth
Authors: Albertsson‐Wikland K , Karlberg J
Published: January 2008

This first report from a population‐based postnatal growth study of 3650 healthy Swedish subjects born at full term provides new reference values for height and weight and shows that over the last 20 years there has been a small secular trend in height (0.2–0.4 SDS over the whole age range) in Sweden in both boys and girls. Within this cohort, 111 (3.1%) were of low birth weight (below –2 SDS) and 141 (3.5%) were of low birth length (below –2 SDS); 54 (1.5%) were both light and short at birth. Of the children born small for gestational age, 87% showed full catch‐up growth within 2 years of life. They attained puberty at a normal or early age and reached a mean final height of –0.7 SDS. The remaining subgroup of 13% born small for gestational age remained below –2 SDS throughout childhood and reached puberty somewhat early. Their mean final height was –1.7 SDS. The current data set is too small to identify possible background factors, but it is being expanded with this objective in mind.
Adult height in children with prepubertal short stature secondary to intrauterine growth retardation
Authors: Chaussain JL , Colle M , Ducret JP
Published: January 2008

In a retrospective study of 47 children seen before puberty for growth retardation secondary to intrauterine growth retardation (IUGR), 23 boys had a final height of 161.9 ± 8.0 cm and 24 girls a final height of 147.6 ± 7.2 cm, values that were significantly lower than the target heights of these patients (p< 0.001). This reduction in adult height indicates the possible usefulness of growth hormone therapy in children with IUGR.
Receptor mutations and haplotypes in growth hormone receptor deficiency: a global survey and identification of the Ecuadorean E180splice mutation in an oriental Jewish patient
Authors: Berg MA , Peoples R , Pérez‐Jurado L , Guevara‐Aguirre J , Rosenbloom AL , Laron Z , Milner RDG , Francke U
Published: January 2008

Eight different mutations were detected in the growth hormone (GH) receptor gene of patients with inherited GH receptor deficiency (GHRD; Laron syndrome) from five continents. All the mutations are located in the extracellular domain of the receptor and are predicted to cause gross structural abnormalities and non‐functional receptor molecules. They include three nucleotide changes in the coding region causing translational stop signals, including the newly identified E183X mutation; two nucleotide changes in introns that affect splice junctions; two dinucleotide deletions that result in stop codons downstream; and one single nucleotide change that activates a donor splice site within an exon and results in a transcript missing 24 nucleotides. This latter mutation (E180splice) was first identified in a cohort of patients with GHRD from southern Ecuador. Based on the fact that the E180splice mutation generates a new cleavage site for the restriction enzyme MnlI, a simple diagnostic test has been developed that can be carried out on dried blood spots collected on filter paper. A total of 55 affected individuals from Ecuador has been found to be homozygous for this mutation. Asymptomatic carriers can also be detected, and 104 of 150 individuals screened were found to be carriers. Using this test, the E180splice mutation has recently been detected in one of two oriental Jewish patients from Israel.
Is there heterozygote expression of growth hormone receptor deficiency?
Authors: Rosenbloom AL , Guevara‐Aguirre J , Rosenfeld RG , Fielder PJ
Published: January 2008

Expression of heterozygosity for the defect in the growth hormone (GH) receptor has been proposed to be reflected in stature, and in GH binding protein (GHBP) and insulin‐like growth factor I (IGF‐I) levels in parents and other relatives of patients with GH receptor deficiency (GHRD; Laron syndrome). The Ecuadorean population with GHRD, in which heterozygosity can be accurately determined in clinically unaffected relatives of probands, offers a unique opportunity to consider this issue. It has previously been demonstrated that 17 parents heterozygous for the Ecuadorean mutation of the GH receptor differed little in biochemical measures (GHBP, IGF‐I, IGF‐II, IGFBP‐2 and IGFBP‐3) from Ecuadorean controls. Mean height SDS of 24 non‐carrier siblings (−1.3 ± 0.95 SD) and 41 heterozygote siblings or offspring of probands (−1.8 ± 1.15) did not differ significantly (p= 0.08). Thus, although there may be slight heterozygote expression of the defective gene for the GH receptor, there is no rationale for counselling based on such minimal variation.
Heart rate increases in patients with growth hormone receptor deficiency treated with insulin‐like growth factor I
Authors: Vasconez O , Martinez V , Martinez AL , Hidalgo F , Diamond FB , Rosenbloom AL , Rosenfeld RG , Guevara‐Aguirre J
Published: January 2008

Cardiac function was measured in 16 prepubertal Ecuadorean patients with growth hormone receptor deficiency given insulin‐like growth factor I (IGF‐I) during part of a clinical trial. The IGF‐I was given subcutaneously twice daily at a dose of 40 μg/kg on days 1 and 2, 80 μg/kg on days 3 and 4, and 120 μg/kg thereafter. Heart rate was determined at baseline (pretreatment) and on days 1–7 by repeated palpation of the radial artery and at baseline and on days 2, 4 and 7 by continuous portable Holter monitoring. Heart rate measured by both methods rose progressively with increasing doses of IGF‐I. The mean palpated pulse exceeded baseline on each treatment day and was significantly higher on day 5 than day 4 and significantly higher on day 3 than day 2. The mean Holter heart rate was significantly higher on day 4 than on day 2 and significantly higher on day 2 than at baseline. Non‐significant glucose and electrolyte changes did not appear to be associated with the cardiac events.
The opportunistic and bacterial infections associated with pediatric Human Immunodeficiency Virus disease
Authors: Nicholas SW
Published: January 2008

Opportunistic and bacterial infections remain the leading causes of death of Human Immunodeficiency Virus‐infected children, despite recent advances in the diagnosis of HIV infection during early infancy; antiretroviral therapies; advances in the treatment of some infections; an improved understanding of the cellular immune systems during early childhood; and new strategies for the prevention of some infections. However, these advances appear to be changing the natural history of pediatric HIV infection, resulting in an improved and longer life for infected children. This article briefly reviews the epidemiology, predictors, and treatments of the most common infections associated with pediatric HIV disease, including Pneumocystis carinii pneumonia, recurrent bacterial infections, candidiasis, herpes group viruses, mycobacterial disease and cryptosporidiosis.
Implications of growth patterns of breast‐fed infants for growth references
Authors: Garza C , Frongillo E , Dewey KG
Published: January 2008

Among the principal tenets of pediatric nutrition is the expectation that meeting the requirements for essential nutrients by feeding either artificial formulae or human milk results in indistinguishable physiological outcomes. This expectation has not been met. Were this observation confined to functional outcomes related to constituents of human milk not found in formula (e.g. immunological components, hormones and very‐long‐chain polyunsaturated fatty acids), differences between breast‐fed and artificially fed infants would not be surprising. However, differences in growth between breast‐ and bottle‐fed infants who live under favorable conditions were mostly unexpected. Bottle‐fed infants demonstrate accelerated growth patterns compared to infants who are breast fed (1, 2). Similarly, differences between the growth of breast‐fed infants and established growth references were not anticipated (2–4).
Characterization of carbohydrates in commercial infant formulae
Authors: Coppa GV , Gabrielli O , Pierani P , Zampini L , Giorgi PL
Published: January 2008

Human milk has always been the reference parameter for the preparation of commercial formulae. The advent of more advanced technologies has enabled increasingly precise information on the composition of human milk to be obtained. Our knowledge in the field of carbohydrates also has improved considerably in the last few years following the pioneering studies of Montreuil (1, 2). From a quantitative point of view it has been demonstrated that in the different phases of lactation, in addition to lactose, human milk contains a consistent amount of oligosaccharides (about 20 g/1 in colostrum and 10–13 g/l in mature milk) (3, 4), whereas monosaccharides make up only about 1% of the total carbohydrates (4). More than 100 different types of oligosaccharides have been identified so far in human milk (5–7), mostly tri‐octasaccharides (8). From a biochemical point of view, oligosaccharides are constituted by glucose, galactose, N‐acetyl‐glucosamine, fucose and sialic acid, and present a linear or branching structure (5). Little is known yet about their physiological role or metabolic fate (9); nevertheless, it has been demonstrated that, in addition to their nutritional function, they participate also in the regulation of the intestinal ecosystem, encouraging the growth of bifid flora (10) and contributing to the defense mechanisms against pathogens in various organs (11–13).
Nutritional requirements of extremely low birthweight infants
Authors: Jr WW Hay
Published: January 2008

Extremely low birthweight (ELBW) infants are unique in many developmental characteristics that determine nutritional requirements, including: low energy reserves (both carbohydrate and fat); higher metabolic rate (intrinsically, due to a higher body content of more metabolically active organs, e.g. brain, heart, liver); higher protein turnover rate (especially when growing); higher glucose needs for energy and brain metabolism; higher lipid needs to match the in utero rate of fat deposition, and for essential fatty acids for brain, neural and vascular development; excessive evaporative rates, and occasionally very high urinary water and solute losses; low rates of gastrointestinal peristalsis; limited production of gut digestive enzymes and growth factors; high incidence of stressful events (e.g. hypoxemia, respiratory distress, sepsis); and abnormal neurological outcome if not fed adequately. Postnatally, ELBW infants do not grow well, or at all, often for weeks. This leads to a virtual “growth deficit”, which has unknown consequences (which for the most part are not good) and requires excessive feeding later on to catch up to normal growth rates and body composition. The major future challenge for the nutrition of these infants is to define more accurately their nutritional requirements, particularly in the early postnatal period, in order to feed them more appropriately, to reduce to a minimum the nutritional and growth deficits that they so commonly develop and to prevent neurodevelopmental handicaps that are the result of nutritional deficiencies.
Parental alcoholism and early child development
Authors: Nordberg L , Rydelius P‐A , Zetterström R
Published: January 2008

In a cohort of 532 pregnant women from the general population, it was found by compilation of the results from interviews, police records, hospital records and social welfare records that 23 mothers and 51 fathers in 64 families (12%) were suffering from alcoholism/heavy drinking. In these 64 families, the mother was an addict in only 13 families, both parents were addicts in 10 families, and in the remaining 41 families only the father was an addict. Pregnancy, delivery, the newborn child and the child's development until their fourth year of life have been described using a multidisciplinary approach and a longitudinal prospective design. An hypothesis on mental and physical development, and the occurrence of psychopathological symptoms in the children was tested. None of the children of the 13 alcoholic mothers was born with foetal alcohol syndrome, but foetal hazard was indicated by lower birth weight and a higher rate of perinatal deaths. Children of alcoholic parents had retarded mental development and showed more behavioural problems until 4 years of age than controls, but the differences related to physical development during the first year of life had then disappeared. Boys were found to be more vulnerable than girls. The consequences of behaviour seemed to be more pronounced when both parents were alcoholics. No obvious deviation was found when only the father was addicted. Regarding mental development, it appears that factors related to parental alcoholism, including genetic and social factors, and the sex of the child, are of greater importance than the neonatal score on reduced optimality.
The fetal alcohol syndrome in adolescence
Authors: Spohr HL , Willms J , Steinhausen HC
Published: January 2008

At present, alcohol is recognized as the leading teratogenic agent in long‐lasting CNS dysfunction. Little is known about the long‐term development and outcome of children with fetal alcohol syndrome (FAS). Forty‐four FAS patients who were diagnosed in early childhood were followed up for 10–14 years. This study documents the developmental changes of the manifestations of FAS from childhood to adolescence and describes a characteristic “juvenile” pattern of FAS, which may help to identify this syndrome even in adolescence. This is especially relevant for patients who were not diagnosed earlier.
Studies on long‐lasting consequences of prenatal exposure to anticonvulsant drugs
Authors: Dessens AB , Boer K , Koppe JG , van de Poll NE , Cohen‐Kettenis PT
Published: January 2008

Based on neonatal examination at birth, it has been estimated that epileptic women have a 2–3 times greater risk of giving birth to an infant with congenital anomalies. But anticonvulsant drugs may also have more subtle influences on the developing foetus which are not visible at birth but only emerge later in life. Evidence for these functional teratogenic influences has been provided by animal research and follow‐up studies in young children. This article discusses these findings in human and animal studies. In addition, the outline of a study carried out at the Department of Obstetrics and Neonatology, Academic Medical Centre, Amsterdam, is described. In this study cognitive functioning, fertility and gender role behaviour of young adults, who had been prenatally exposed to barbiturates and/or hydantoins was examined.
Energy requirements in sick preterm babies
Authors: Wilson DC , McClure G
Published: January 2008

The energy requirements of healthy preterm babies are well documented in the literature. However, the clinical load in neonatal intensive care units is due to sick preterm infants requiring prolonged mechanical ventilation, many of whom will develop bronchopulmonary dysplasia. It is this group in which knowledge of energy requirements is scanty. This group also has poor energy reserves and is often intolerant of enteral and parenteral nutrition. In this article, we will review methods of measurement of energy expenditure, methodological problems when applied to ill infants and published results of energy expenditure measurements in sick preterm babies. We will review the link between energy reserves, energy intake and energy expenditure. The problems of undernutrition in early postnatal life and possible consequences in adult life will be discussed.
Protein turnover in low‐birth‐weight (LBW) infants
Authors: Beaufrére B
Published: January 2008

Protein deposition in infants results from an equilibrium between protein synthesis and degradation. Separate measurements of these two simultaneous processes are required for a better understanding of the mechanisms and regulation of growth. Current methods of assessment of whole‐body protein synthesis and degradation rely on the use of stable isotope labelled tracer and are briefly reviewed and discussed (“end‐products” and precursor method) with an emphasis on their practical and conceptual limits. Overall, protein turnover is higher in infants than in adults, but there are discrepancies within the literature, which are mostly due to methodological differences. The relationships between energy expenditure and protein turnover and the mechanisms of protein deposition during feeding (which is inhibition of protein degradation rather than stimulation of protein synthesis) are also described. Finally, we review the few available data on protein turnover modifications induced by various pathophysiological states.
The STR system in the human phenylalanine hydroxylase gene: true fragment length obtained with fluorescent labelled PCR primers
Authors: Zschocke J , Graham CA , McKnight JJ , Nevin NC
Published: January 2008

We present a simple, fast, non‐radioactive method for the analysis of the polymorphic short tandem repeat (STR) system in the human phenylalanine hydroxylase gene. Previously, sizing of the STR marker involved radiolabelling of PCR amplified fragments and resolution on denaturing polyacrylamide gels using M13 sequencing ladder as a standard. However, this method consistently gave sizes 2 bp longer than the known sequence. The fluorescent method presented here employs internal lane standards and enables accurate sizing of the fragments. To avoid confusion, we suggest that the true fragment lengths are used as reference values in the future. The analysis of STR alleles is valuable for population genetic studies and for targeted mutation screening in phenylketonuria (PKU). It can replace RFLP‐based haplotype analysis for carrier detection, and we report its use for prenatal diagnosis in a Northern Irish family with PKU. The analysis of 250 Northern Irish chromosomes, including 128 PKU alleles, showed no significant difference between normal and PKU alleles, with fragment lengths of 238 and 242 bp most common in both groups.
Psychopathology of patients treated early for phenylketonuria: results of the German collaborative study of phenylketonuria
Authors: Burgard P , Armbruster M , Schmidt E , Rupp A
Published: January 2008

At the age of 13 years, 60 adolescents, suffering from phenylalaninemia due to hydroxylase deficiency, and their mothers were simultaneously investigated with standardized psychiatric interview in order to determine the adolescents' psychiatric status. Forty symptoms related to emotional disorders, antisocial and conduct disorders, hyperkinetic syndromes, and specific symptoms like psychophysiological pains, enuresis, encopresis, tics, stereotypies, and eating disorders were examined. Severity level was rated as undisturbed, mild, moderate, and severe disturbance. Comparison with representative sample of 191 age mates revealed a double rate of moderate disturbances for the PKU sample. There was no association between severity level and sex as well as mean phenylalanine level during the first 13 years of the patients' lives. No PKU specific diagnosis could be determined. WISC‐R‐IQ below 90 was associated with threefold risk of more severe disturbance and patients with more than three adverse familial circumstances had a 50% chance of getting a psychiatric diagnosis. It is concluded that the observed disturbances result from stress associated more with the chronic condition than with the increased phenylalanine level.
The international collaborative study of maternal phenylketonuria: status report 1994
Authors: Koch R , Levy HL , Matalon R , Rouse B , Hanley WB , Trefz F , Azen C , Friedan EG , de la Cruz F , Güttler F , Acosta PB
Published: January 2008

Neonatal screening for phenylketonuria (PKU) has created a problem as females with PKU are reaching child‐bearing age. Surveys have revealed that maternal phenylalanine blood concentrations greater than 1200 μmol/l are associated with fetal microcephaly, congenital heart defects and intrauterine growth retardation. It is estimated that as many as 3000 hyperphenylalaninemic females may be at risk of producing these fetal abnormalities. To examine this problem, the international maternal PKU collaborative study was developed to evaluate the efficacy of a phenylalanine‐restricted diet in reducing fetal morbidity. Preliminary findings have indicated that phenylalanine restriction should begin before conception for females with PKU planning a pregnancy. Dietary control should maintain maternal blood phenylalanine levels between 120 and 360 μmol/l and should provide adequate energy, protein, vitamin and mineral intake. Pregnant hyperphenylalaninemic females who achieved metabolic control after conception or by the 10th week of pregnancy had a better offspring outcome than anticipated. The results of 402 pregnancies are reviewed.
Human Milk Lacto‐Engineering: Growth Nitrogen Metabolism, and Energy Balance in Preterm Infants
Authors: VOYER M. , SENTERRE J. , RIGO J. , CHARLAS J. , SATGE P.
Published: January 2008

ABSTRACT. Fourteen 3‐day metabolic balance studies were carried out in 8 healthy male preterm infants (birthweight 1270±170 g, gestational age 30±2 weeks) fed 183±7 ml/kg/day of a human milk formula made of incompletely skimmed human milk enriched with lyophilized whole human milk, minerals, medium chain triglycerides and linoleate. Daily intakes per kilo bodyweight were for protein 3.5±0.3 g, fat 7.0±2.1 g, and energy 573±88 kj (137 kcal). Weight gain was 29±5 g per day and nitrogen retention was 317±52 mg/kg/day. Fat absorption was 76± 12 %. Renal acid and solute loads were low and there was no metabolic acidosis, hyperazotemia or hyperaminoacidemia, except for tyrosine. It is concluded that preterm infants fed a human milk formula have similar growth rates and nitrogen retentions as foetuses in utero or preterm infants fed their own mother's milk.
Time‐Lapse Filming of Newborn Infants: A new Technique in Monitoring of Behavioral States
Authors: WALLIN A.
Published: January 2008

ABSTRACT. Knowledge of the newborn infant's behavior is of great importance for an understanding of postnatal adaptation and the influence of exogenous stimuli, such as drugs. To date, however, the methods used have been too sophisticated and complex for use on a busy ward. Moreover, procedures for monitoring physiological parameters in this age group should be non‐invasive and gentle for the infant, and acceptable to parents and personnel. In this paper, a simplified technique is presented where observation of the infant can be registered with an ordinary super‐8 movie camera adapted to time‐lapse. Heart rate, EMG and vocalization are recorded simultaneously. The time‐lapse filming technique is relatively easy to learn, it is simple and economic and can be used even during routine clinical care. Assessments were made from the films only, from the recordings only and from a combination of films and recordings. All these modes of assessment were found to be satisfactorily reproducible. Filming combined with respiratory recording gives sufficient information to classify neonatal infant behavior.
ACTH in Normal Children and Children with Pituitary and Adrenal Diseases
Authors: PETERSEN KNUD E.
Published: January 2008

ABSTRACT. During insulin hypoglycaemia (IH) reference values for plasma ACTH are 10 to 88 pg/ml at 0 min and 50 to 300 pg/ml at 40 min. Plasma Cortisol reference values are above 400 nmol/l at 40 min. A negative correlation between age and ACTH response was found in normal children. ACTH response during IH in 43 children and adolescents with deficient production of one or several pituitary hormones was significantly lower (median 81 pg/ml at 40 min), than the response in normal children (median 149 pg/ml). Thirty‐six patients with idiopathic hypopituitarism could be grouped into 21 with normal, 6 with borderline (50 to 70 pg/ml at 40 min), and 9 with abnormal ACTH response. In 7 patients with intracranial tumour 2 had normal, 3 borderline, and 2 abnormal ACTH response. A good correlation between the ACTH peak at 40 min and the Cortisol value at 40 min was found in patients with idiopathic hypopituitarism. ACTH response also correlated well with the plasma growth hormone (GH) response in the patients. It is recommended to study ACTH together with GH when IH is performed, multiple disturbances are often found in children with GH deficiency and demonstration of an ACTH defect has therapeutic implications.
Comparison of Plasma Clearances of Polyfructosan and 51Cr‐EDTA in Children
Authors: APERIA A. , FREYSCHUSS U.
Published: January 2008

ABSTRACT. Plasma clearances of polyfructosan and 5lCr‐EDTA were determined in 38 children with renal diseases and in five healthy children in order to compare the values for the glomerular filtration rate (GFR) obtained by single injection procedures. Both one‐compartment (Cr‐EDTA‐1) and two‐compartment (Cr‐EDTA‐2) analyses were made of the isotope decay curve. The children were divided into two age groups: (a) 24 children below 6 years, and (b) 19 children between 8 and 16 years of age. In both groups Cr‐EDTA‐1 GFR and Cr‐EDTA‐2 GFR correlated significantly with polyfructosan GFR. The correlation coefficients, however, were somewhat lower in the younger (r= 0.74, r= 0.73) than in the older children (r= 0.91, r= 0.93). There were no significant differences between simultaneously obtained polyfructosan GFR and Cr‐EDTA‐2 GFR based on paired observations while Cr‐EDTA‐1 GFR was somewhat higher (16 %) than the simultaneously obtained polyfructosan GFR. We conclude that estimates of GFR from polyfructosan and Cr‐EDTA clearances based on two compartment analyses and single injection procedures are interchangeable