bluuebunny/crossref_metadata_2025 huggingface dataset:
Abortion requests among adolescents in comparison with young adults in a Swiss region (1990–1998)
Authors: Narring F , Roulet N , Addor V , Michaud P‐A
Published: August 2010

Aim: To examine the recent evolution of abortion request rates among adolescents and young adults in the Canton of Vaud (Switzerland) and to describe the circumstances of the abortion requests and sociodemographic characteristics by age subgroups and nationality. Method: Data for women aged 14 to 24 y living in Vaud were selected from the 12358 abortion requests from residents aged 14–49 y between 1990 and 1998. Results: Overall, abortion request rates by age were stable over the study period. However, rates for non‐Swiss women were two to three times higher than those for Swiss women, at 4.5 [95% confidence interval [CI]: 3.8–5.2] vs 2.4 [95% CI: 2.1–2.7] per 1000 adolescents below the age of 18, 18.1 [95% CI: 17.2–18.9] vs 8.0 [95% CI: 7.1–8.8] per 1000 women aged 18–19 and 30.5 [95% CI: 29.1–32.0] vs 10.2 [95% CI: 9.6–10.8] per 1000 women aged 20–24. The ratio of abortions to live births was greatest for women under 20 y of age, at 1.9, in comparison with the ratio observed among adult women aged 20–24 (at 0.4). The abortion rate per 1000 conceptions >6 wk remained stable; this rate was 590 per 1000 among 14–19‐y‐olds in 1997.

Conclusion: The abortion request rate among youths in this Swiss region has not increased between 1990 and 1998. Efforts must be intensified to ensure universal access to family planning services and contraception, especially for young foreign women and adolescents.
Amplitude‐integrated encephalography in pyridoxine‐dependent seizures and pyridoxine‐responsive seizures
Authors: Hellström‐Westas L , Blennow G , Rosén I
Published: August 2010

Pyridoxine‐dependent seizures are rare in newborn infants, although recent data suggest that the prevalence probably is underestimated. In all newborn infants with recurrent epileptic seizures the general recommendation is to administer pyridoxine and simultaneously record an electroencephalogram (EEG).

Conclusion: One infant with pyridoxine‐responsive seizures and another with pyridoxine‐dependent seizures had different electroclinical responses on amplitude‐integrated EEG monitoring (aEEG) when pyridoxine was administered.
Tracheobronchial aspirate fluid neutrophil lipocalin, elastase‐ and neutrophil protease‐4–α1‐antitrypsin complexes, protease inhibitors and free proteolytic activity in respiratory distress syndrome
Authors: Sveger T , Ohlsson K , Polberger S , Noack G , Mörse H , Laurin S
Published: August 2010

This study aimed to determine whether the protease/protease inhibitor balance and neutrophil activity is of pathophysiological importance in the severity and resolution of respiratory distress syndrome (RDS) and the eventual development of neonatal chronic lung disease (CLD). Ventilated preterm infants with RDS (n= 43) were studied during their first week of life. Tracheobronchial aspirate fluid (TAF) concentrations of neutrophil lipocalin, the elastase‐ and neutrophil protease‐4 (NP4) complex concentrations, and α1‐antitrypsin (α1AT), antichymotrypsin (ACT) and secretory leucocyte protease inhibitor (SLPI) levels were analysed. Free proteolytic and elastolytic activities were also determined. CLD correlated with low α1AT (p= 0.02) and ACT (p= 0.02) levels at 3–4 d of age and low SLPI (p= 0.03) at 7–8 d of age. No correlations were found between CLD or severity of RDS (as judged from radiological examination) and neutrophil lipocalin, elastase‐and NP4–α1AT complexes during the first week of life, with one exception: RDS X‐ray severity and the elastase–α1AT complex concentration were correlated at 3–4 d of age (p= 0.02). Free proteolytic activity occurred in the TAF of 7/30 infants tested on day 3–4 and free elastolytic activity in 1 patient. During the rest of the first week of life no free elastolytic or proteolytic activities were observed. Caesarean section was correlated with low levels of SLPI on day 3–4 (p= 0.01), NP4 (p= 0.03) and ACT (p= 0.05) on day 5–6. Gestational age was positively correlated with protease inhibitors and their complexes at 3–4 d of age.

Conclusion: Free proteolytic or elastolytic activity in the TAF of RDS infants in the first week of life occurred by way of exception. Elastase–/NP4–α1AT complex or neutrophil lipocalin levels were not correlated with the development of CLD. The correlation between CLD and low α1AT or ACT at 3–4 d and SLPI at 7–8 d of age may be due to either immaturity or complex formation. The severity of RDS as judged from radiological examination was correlated with elastase–α1AT complex on day 3–4. The main hypothesis, that TAF protease/protease inhibitor levels or imbalance and leucocyte activity are important factors indicating a high risk of severe RDS and subsequent CLD development, was principally not confirmed.
Early diagnosis of primary ciliary dyskinesia in a newborn without situs inversus
Authors: Bromiker R , Neeman Z , Bar‐Oz B , Avital A , Bar‐Ziv J , Springer C
Published: August 2010

Primary ciliary dyskinesia has been reported as a rare cause of respiratory distress during the neonatal period. This diagnosis is readily suspected in cases presenting with accompanying situs inversus. The aim of this study was to report on a pair of siblings with primary ciliary dyskinesia. The first case was an infant diagnosed with primary ciliary dyskinesia at the age of 14 d despite lack of situs inversus. The infant had presented with respiratory distress and atelectasis almost immediately after birth. The sibling, born one year later, presented with situs inversus, therefore allowing diagnosis of primary ciliary dyskinesia to be made immediately after birth.

Conclusions: Diagnosis of primary ciliary dyskinesia should be considered in newborns presenting with respiratory distress or atelectasis. Early institution of an adequate treatment programme and follow‐up may reduce or prevent further complications of the disease.
Embryonic hematopoiesis in mice and humans
Authors: Yoder MC
Published: August 2010

Aim: The aim of this report is to review briefly the ontogeny of hematopoiesis in mice and humans and to discuss recent evidence for an intraembryonic source of hematopoietic stem cells. Methods: The hematopoiesis overview summarizes information present in the PubMed online database and from experiments conducted in our laboratories. Results: The major sites of hematopoiesis change throughout development in mice and humans. Recent evidence suggests that hematopoietic cells may emerge from mesoderm precursors within the embryo as well as in the yolk sac.

Conclusion: The ontogeny of hematopoiesis is similar in mice and humans. The murine system is a useful model to study the earliest events involved in forming hematopoietic stem cells.
Oxidant injury in neonatal erythrocytes during the perinatal period
Authors: Bracci R , Perrone S , Buonocore G
Published: August 2010

It has been known for many decades that oxidative stress leads to oxidation of hemoglobin and damage to the erythrocyte membrane. More recently, the factors involved in denaturating of membrane proteins and lipid peroxidation have been investigated in detail, as well as the mechanism of reactive oxygen species formation in red cells. Oxidative stress depletes adenosine triphosphate (ATP) and adenine nucleotides, whereas adenosine monophosphate (AMP) deaminase seems to depress energy metabolism by blocking the salvage pathway of purine nucleotides. Depletion of ATP and activation of AMP deaminase are related to calcium ion concentrations. Denaturating of membrane proteins generally precedes lipid peroxidation and consequent phagocytosis due to caspase activation. Extensive investigations demonstrated the key role of oxidative stress and iron release in a reactive form causing membrane protein damage via the Fenton reaction and hydroxyl radical production. In the absence of efficient protection by antioxidant factors and other molecules such as flavonoids, oxidative stress is responsible for the release of iron in reactive form, predisposing red cells to hemolysis through the formation of senescence antigen. Other well‐known sources of oxidative stress in red cells are free radical production outside the red cell by activated phagocytes, endothelial metabolism, hyperoxia, ischemia‐reperfusion and the arachidonic acid cascade.

Conclusion: The recent insight into the mechanism of oxidative injury of red cells and evidence of relationships between erythrocyte oxidative stress and hypoxia suggest that increased hemolysis is induced by severe hypoxia and acidosis in the fetus as well as the newborn.
Angiokeratoma corporis diffusum – Fabry disease: historical review from the original description to the introduction of enzyme replacement therapy
Authors: Fabry H
Published: August 2010

This paper gives a brief historical overview of Fabry disease. First described in 1898 and called angiokeratoma corporis diffusum, a succession of observations and pioneering clinical research over the past 100 years has led to our present understanding of the disease. The major milestones during this time are described, as is the work that resulted in the successful introduction of enzyme replacement therapy.
Screening for fragile X syndrome: results from a school for mentally retarded children
Authors: Hec̀imovic̀ S , Tarnik I Petek , Baric̀ I , Čkarun Ž , Pavelic̀ K
Published: August 2010

Fragile X syndrome is the most common inherited form of familial mental retardation. The purpose of this study was to identify yet unrecognized fragile X individuals and to estimate the frequency of both the FRAXA and FRAXE forms of the disease in a population of mentally retarded children attending a special school in Croatia. The results are reported of molecular screening of 114 children with mild to severe mental retardation. Three individuals (2.6%) with the FRAXA form of the fragile X syndrome and one boy (0.9%) with FRAXE mental retardation were detected; a total of four newly diagnosed fragile X families were identified. Closer clinical examination revealed that behavioural and speech disturbances were clearly present among all fragile X cases (both FRAXA and FRAXE), indicating that these features could be additional diagnostic criteria for the preselection of individuals at risk.

Conclusion: Fragile X screening among mentally retarded children attending a special school should be highly encouraged to reveal the cause of mental retardation and to detect yet unrecognized fragile X individuals. The frequency of fragile X syndrome in a such population in Croatia was found to correlate with similar results from previous studies. However, since at the time of diagnosis all affected families had a second or even a third child born, earlier diagnosis should be considered to provide greater benefit to fragile X families.
Quantitative evaluation of the changes in plasma concentrations of cardiac natriuretic peptide before and after transcatheter closure of atrial septal defect
Authors: Muta H , Ishii M , Maeno Y , Akagi T , Kato H
Published: August 2010

The purpose of this study was to investigate the changes in plasma concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in patients with atrial septal defect (ASD) during transcatheter closure of defects. The plasma concentrations of ANP and BNP were obtained from 14 patients with ASD at before closure, and at 5 min, 24 h, 1 mo and 3 mo after transcatheter ASD closure using an Amplatzer septal occluder. Ten healthy children aged 6–18 y were studied as controls. All ASDs were successfully closed. Compared with control values (mean ± SD, 17 ± 6.8 ng l‐1), ANP concentrations before closure were significantly elevated (24 ± 9.8 ng l‐1, p > 0.05). ANP concentrations increased significantly at 5 min after closure (34 ± 18 ng l‐1, p > 0.05) compared with preclosure concentrations. At 24 h after closure, the concentrations decreased to values not different from control values (19 ± 11 ng l‐1, p= ns). BNP levels before closure (19 ± 9.9 ng l‐1) were also elevated significantly compared with control values (12 ± 4.9 ng l‐1, p > 0.05). BNP concentrations increased significantly at 5 min after closure (23 ± 14 ng l‐1, p > 0.05) compared with preclosure concentrations. ANP values at 24 h were lower than at 5 min after closure, whereas BNP values were higher (32 ± 11ng l‐1, p > 0.05). As with ANP, the concentrations gradually decreased to values not different from control values at 3 mo after the procedure (12 ± 6.3 ng l‐1, p= ns).

Conclusion: Plasma concentrations of ANP and BNP may become effective markers for evaluating changes in cardiac load after transcatheter ASD closure.
Cross‐sectional survey of paranasal sinus magnetic resonance imaging findings in schoolchildren
Authors: Kristo A , Alho O‐P , Luotonen J , Koivunen P , Tervonen O , Uhari M
Published: August 2010

Aim: Sinus image abnormalities are common among children examined for indications other than sinus disease. The purpose of this study was to determine the frequency of sinus abnormalities among otherwise healthy children attending school. Methods: Magnetic resonance imaging (MRI) was performed on 24 children aged 8–9 y, 18 of whom were re‐examined after 6–7 mo. Results: Sinus abnormalities were common. An abnormality was seen in 12 of the children [50%, 95% confidence interval (95% CI) 29–71%], and 9 (38%, 95% CI 19–59%) had abnormalities in the maxillary sinuses. As many as 8 (42%, 95% CI 20–67%) of the asymptomatic children (lacking clinical symptoms or findings) had abnormalities in the maxillary or ethmoidal sinuses. The follow‐up examination showed that about half of the abnormal sinus MRI findings had resolved or improved without any intervention.

Conclusion: Abnormal sinus MRI findings are common both among otherwise healthy children attending school and in totally asymptomatic children. As incidental findings, these should be interpreted as normal and do not indicate any need for treatment in children imaged for purposes other than sinus disease.
Effect of maternal antibiotic treatment on fetal periventricular white matter cell death in a rabbit intrauterine infection model
Authors: Debillon T , Gras‐Leguen C , Vérielle V , Caillon J , Roze J‐C , Gressens P
Published: August 2010

Aim: To evaluate the effects of maternal antibiotic treatment on fetal brain cell death in a rabbit intrauterine infection model. Methods: After Escherichia coli uterine‐horn inoculation in 22 pregnant rabbits, followed at various times by ceftriaxone and caesarean section, cell death in white matter (histology and fragmented DNA staining) from fetuses killed at extraction was compared across groups using the Mantel‐Haenszel test and Fisher's exact test for small numbers. Results: White matter cell death was consistently present at 48 h, with ceftriaxone initiation at 24 h (group 1), detectable at 84 but not 60 h, with ceftriaxone initiation at 12 h, and significantly reduced at 84 h with ceftriaxone initiation at 6 h (60% vs 100% in group 1, p < 0.001, Fisher's exact test).

Conclusion: Early maternal antibiotic therapy delays white matter cell death in rabbit fetuses exposed to intrauterine infection. This may provide a window for preventing white matter damage.
Cerebral venous thrombosis and Escherichia coli infection in neonates
Authors: Farstad H , Gaustad P , Kristiansen P , Perminov G , Abrahamsen TG
Published: August 2010

Aim: To present a possible association between cerebral venous thrombosis (CVT) and infection with Escherichia coli. Methods: Four neonates with deep CVT occurring during an E. coli infection are presented. Results: In these patients the thrombotic disease was found by Doppler ultrasonography. The thrombosis involved at least the sagittal sinus and the transverse sinus according to subsequent MRI scans. The E. coli strains did not produce verotoxin or haemolysin. Disseminated intravascular coagulation was not demonstrated. Three patients presented with seizures. At discharge, all of the patients had signs of neurological damage, but two of them have improved significantly since then. None of the patients has had recurrent (venous) thrombosis.

Conclusion: E. coli infections in neonates may predispose to CVT, a finding that has clinical implications.
Growth in weight and length
Authors: Whitehead RG
Published: August 2010

Some of the complex factors that can affect growth in weight but especially in height are discussed. It is emphasized that although due attention needs to be paid to diet and the regular provision of the extra macro‐ and micro‐nutrients needed during catch‐up growth, other considerations are just as important.

Conclusion: As well as dealing with the problem of poor sanitation and consequent frequent infection in developing countries, social stimulation and the restoration of a feeling of well‐being and general happiness can be just as important.
Snoring in the first year of life
Authors: Mitchell EA , Thompson JMD
Published: August 2010

Aim: To describe the prevalence of snoring in infancy and the factors associated with snoring. Methods: The investigation comprised a cross‐sectional study of 1800 infants. Snoring was ascertained by interviewer‐administered questionnaire. Results: The prevalence of snoring was 15.8% in the first 4 wk of life and 26.1% in the past 2 wk. Snoring in the past 2 wk was associated with increasing age of the infant, male gender, maternal smoking, sleep position, number of respiratory infections and snoring in the first 4wk of life after adjustment for potential confounders. No associations were found with snoring in the first 4 wk of life.

Conclusion: Snoring is common in infancy. The identified risk factors for snoring are probably causally related to snoring. Further studies are needed to establish whether snoring in infancy is associated with current or subsequent morbidity.
Copper in drinking water: not a strong risk factor for diarrhoea among young children. A population‐based study from Sweden
Authors: Pettersson R , Rasmussen F , Oskarsson A
Published: August 2010

Aim: To assess whether mean daily intake of copper or maximal concentration of copper in drinking water is related to the incidence of diarrhoea and vomiting among young children. Methods: Mean daily intake of copper from drinking water was estimated prior to episodes of diarrhoea among 430 children aged 9 to 21 mo. A total of 4703 samples of tap water were collected in the homes of the children. The mean daily intake of copper and the maximal concentration of copper in samples of consumed water were used as measures of exposure. The cumulative incidence of acute diarrhoea and vomiting was studied during 12wk of follow‐up. Cases of diarrhoea caused by viral and bacterial infections were identified. Results: The median copper level of the mean value for each child was 0.61 mg/L with 10th and 90th percentiles of 0.04 and 1.57 mg/L. Among the 430 children, 43 had episodes of acute diarrhoea, of which 23 had no identified viral or bacterial origin, and vomiting was reported in 95 children. No significant associations were found between daily intake of copper or maximal concentration of copper in drinking water and the risk of diarrhoea or vomiting.

Conclusion: There is unlikely to be a strong association between daily intake of copper or maximal concentration of copper in drinking water and the risk of diarrhoea or vomiting within the range of copper intakes/concentrations studied.
Kawasaki disease in parents and children
Authors: Uehara R , Yashiro M , Nakamura Y , Yanagawa H
Published: August 2010

Aim: To estimate the probability that the parents of patients with Kawasaki disease also had a history of the same disease. Methods: Self‐reported parents’histories of Kawasaki disease were collected from data of the 16th nationwide survey of the disease conducted in Japan from January 1999 to December 2000. The incidence of Kawasaki disease was calculated by using data reported in all 16 nationwide surveys and live births in the Japanese vital statistics. The expected number of parents with a history of Kawasaki disease in the general population, which was calculated by using the assumed number of parents in the vital statistics and the incidence of this disease, was compared with the observed number. Results: Among 14163 parent pairs of patients with Kawasaki disease, 33 parents (25 mothers and 8 fathers) had a history of the disease. The number of parents expected to have a history of Kawasaki disease was 16.1 (8.4 mothers and 7.7 fathers). From a Poisson distribution, the probability of the observed number was less than 0.001 among parents or mothers. The prevalence of a recurrence of Kawasaki disease and incidences involving siblings of patients whose parents had a history of the disease were five or six times higher than those of all patients who were reported in the 16th survey.

Conclusion: When compared with parents in the general population, the probability of a history of Kawasaki disease was significantly higher in those parents whose children suffered from the same disease. This suggests that, epidemiologically, a genetic predisposition to Kawasaki disease may be implicated in its occurrence.
Lung volume reduction surgery in bronchopulmonary dysplasia
Authors: Siaplaouras J , Heckmann M , Reiss I , Schaible T , Waag KL , Gortner L
Published: August 2010

We report on a female preterm infant of 29 wk gestational age, who developed acquired lobar emphysema after prolonged artificial ventilation secondary to respiratory disease syndrome and bronchopulmonary dysplasia. The infant underwent atypical segmentectomy at the age of 12 mo because of life‐threatening hypoxaemia with pulmonary hypertension and failure of conservative treatment.

Conclusion: Lung volume reduction surgery (LVRS) dramatically improved the respiratory function and resulted in adequate weight gain and psychomotor development. In selected cases LVRS can be an option for lobar emphysema in premature infants with severe bronchopulmonary dysplasia.
Corticosteroids for the treatment and prevention of chronic lung disease
Authors: Soll R. F.
Published: August 2010

Postnatal corticosteroids may prevent chronic lung disease in ventilated very low birthweight infants. However, concern regarding serious neurodevelopmental consequences of therapy has led to strong recommendations to curtail use of this treatment.

Conclusion: Despite the high risk of severe neurological side effects, centers in Europe and North America continue to utilize postnatal corticosteroids, frequently in a fashion that is not supported by the available evidence.
Increased QT dispersion in epileptic children
Authors: Akalin F , Tirtir A , Yilmaz Y
Published: August 2010

Aim: Epilepsy is a common paroxysmal disorder in childhood. Tachyarrhythmia, bradyarrhythmia, asystole, atrioventricular block, ventricular fibrillation or sudden death may occur during seizures. Mutations of ion‐channel coding genes are found in patients with idiopathic or cryptogenic epilepsy. The ion channels also play a role in arrhythmogenesis. QT dispersion is a non‐invasive method for assessment of regional repolarization differences within the myocardial tissue. This study investigated QT and QTc dispersion (QTcd) and the risk of dysrhythmia in epileptic children. Methods: The first group included 28 patients with newly diagnosed epilepsy and not taking antiepileptic treatment (range 10 mo to 15 y, mean ± SD 6.86 ± 3.92 y), the second group included 34 patients taking antiepileptic treatment (range 1–14 y, mean ± SD 7.51 ± 3.68y) and the control group included 52 healthy children (range 4 mo to 15 y, mean ± SD 6.94 ± 3.92 y). Twelve‐lead ECGs were obtained and heart rate, RR interval, P wave amplitude and duration, PR interval, QRS duration, QRS axis and QT intervals were measured, and QTc, QTd, QTcd were calculated in all subjects. The measurements were repeated in the first group under antiepileptic treatment. Results: While no significant difference in terms of heart rate, RR interval, P wave amplitude and duration, PR interval, QRS duration, QRS axis, QT intervals or QTc intervals was found, QTd and QTcd values were significantly increased in epileptic children compared with the control group. QTd was 58.1 ± 13.4 ms and 35.9 ± 9.3 ms and QTcd was 91.0 ± 22.9 and 68.6 ± 18.0 ms in patients and controls, respectively. Antiepileptic treatment did not affect QT dispersion.

Conclusion: QT dispersion is increased in epileptic children. Further investigation is needed to reveal the pathogenesis of myocardial repolarization abnormalities in epileptic patients.
Nutritional relevance of trans isomeric fatty acids in human milk
Authors: Decsi T
Published: August 2010

Trans isomeric fatty acids amount to about 2% of the fatty acid composition of human milk in Europe, whereas lower values were seen in Africa, and higher values were reported for North‐America. At least five human studies indicate that trans fatty acids may interfere with the metabolism of long‐chain polyunsaturated fatty acids.

Conclusion: Trans isomeric fatty acids in human milk should be regarded as a potential confounding variable in studies investigating the role of long‐chain polyunsaturated fatty acids in the development of breastfed infants.
Cardiac troponin I, cardiac troponin T and creatine kinase MB concentrations in umbilical cord blood of healthy term neonates
Authors: Trevisanuto D , Pitton M , Altinier S , Zaninotto M , Plebani M , Zanardo V
Published: August 2010

Aims: To measure and compare cardiac troponin I, cardiac troponin T and creatine kinase MB concentrations in the umbilical cord blood of healthy term infants and to investigate the relationship between maternal and neonatal troponin values at birth. Methods: Troponin I, troponin T and creatine kinase MB concentrations were measured from the umbilical cord samples of 85 healthy term neonates and in the blood samples of their respective mothers at birth. Results: Median (interquartile range) umbilical cord concentrations were 0 μg/L (0–0) for troponin I, 0 μg/L (0–0.019) for troponin T and 4.90 μg/L (3.90–6.61) for creatine kinase MB. Troponin I and T concentrations were higher than the detection limit for the assay in 2 (2.3%) and 41 (48.2%) neonates, respectively. Two mothers (2.3%) had cTnT levels above the detection limit; none of them had increased levels of cTnI.

Conclusion: Probably owing to differences in expression and assay detection limits, cord blood troponin T concentrations are frequently over the detection limit at birth, while troponin I is mostly undetectable and comparable with that in healthy pregnant women. These cardiac regulatory proteins are of neonatal origin and are not influenced by maternal levels.
Compliance of present recommendations of fatty acids in formulas for term infants with the actual human milk fatty acid composition in different populations
Authors: Agostoni C
Published: August 2010

Fats are the only dietary agents possibly modulating the individual membrane composition, which otherwise is “genetically” determined. In infancy, human milk represents the first natural source of fats. Although the fat intake of breastfed infants is quantitatively and qualitatively unique, it is not known to what extent their varying requirements are met by the fat composition in the milk of their mothers.

Conclusion: The fat composition of arbitrarily chosen human milk is not always the best standard for that in infant formula.
Disaccharidase activities in Belgian children: reference intervals and comparison with non‐Belgian Caucasian children
Authors: Blomme B , Gerlo E , Hauser B , Vandenplas Y
Published: August 2010

Aim: To establish reference values for disaccharidase activities in Belgian children and to compare enzyme activities with those of non‐Belgian Caucasian children. Methods: Data from Belgian children who had undergone endoscopic jejunal biopsies (1994–2000) for suspected malabsorption were reviewed. The patients were divided into three groups based on histology: (A) normal (n= 201), (B) moderate changes (n= 58) and (C) (sub)total atrophy (n= 14). The 95% reference limits for disaccharidase activities (U/g protein) were calculated for group A after exclusion of patients with a positive hydrogen breath test, a history of lactose intolerance or coeliac disease (final population: n=151, 0.1–12 y). Values were compared with those of 34 non‐Belgian Caucasian children with normal histology (28 of Mediterranean origin). Results: The reference limits (90% confidence interval) were 86 (65–111)–423 (366–494) for maltase, 9 (6–12)–91 (78–122) for lactase and 24 (18–30)–155 (120–184) for sucrase. No gender‐related differences in enzyme activities were found. Lactase levels showed a slight decrease with increasing age. Disaccharidase activities of children with histologically confirmed mucosal injury were significantly lower than those of children with normal histology: median values for groups A, B and C were 208, 181 and 96, respectively, for maltase, 40, 28 and 7, respectively, for lactase and 69, 54 and 25, respectively, for sucrase. Median disaccharidase activities in biopsies with normal histology were lower in non‐Belgian children, the difference being only statistically significant for lactase, 33 versus 40.

Conclusion: The reference values for Belgian children are well in line with other reported values from Caucasian children. Although enzyme activities are lower in children with histologically confirmed mucosal damage, they do not allow differentiation between histology groups. Lower lactase values were found in non‐Belgian children.
Birth season and environmental influences on patterns of thymic growth in rural Gambian infants
Authors: Collinson AC , Moore SE , Cole TJ , Prentice AM
Published: August 2010

Aim: In rural Gambia, birth season predicts infection‐related adult mortality. Seasonal factors in early life may programme the immune system, possibly via an effect on thymic development. This study tested whether thymus size in rural Gambian infants is affected by birth season, defined as January‐June (harvest, few infections) versus July‐December (hungry, high infectious load). Methods: Thymic volume (thymic index) was assessed sonographically at 1, 8, 24 and 52 wk in 138 singleton infants born over 14 consecutive months. Growth and morbidity were regularly assessed. Results: Mean thymic index increased from 19.9 at 1 wk to 30.9 at 8 wk and 35.7 at 24 wk, then fell to 32.0 at 52 wk. Thymic index was associated with each preceding thymic index up to 24 wk. This tracking persisted after correcting for infant weight and month of measurement (p < 0.01). Thymic index at 1 wk was marginally but non‐significantly lower in hungry season births (p= 0.06). Thymic index was lower in hungry season measurements; this effect persisted after adjusting for current weight and infection markers, and was strongest at 8 wk (p= 0.001).

Conclusion: These results describe a pattern of thymic growth followed by diminution in size. An infant's thymic index tracks despite changes in body weight and season. Thymic index was lower in the hungry season. This appears not to be explained by infection or nutritional status. A possible influence of trophic factors in breast milk merits investigation.
Pinpoint skin lesions in a familial hypercholesterolaemia homozygote
Authors: Milionis HJ , Miltiadous GA , Cariolou M , Elisaf MS
Published: August 2010

The case is reported of a 2‐y‐old girl referred to the outpatient lipid clinic because of a tiny cutaneous xanthoma on the dorsum of the left foot and a family history of hyperlipidaemia and coronary heart disease (CHD). Fasting serum total cholesterol levels were remarkably high (27.1 mmol l−1, 1050 mg dl−1) and DNA analysis confirmed homozygous familial hypercholesterolaemia (class II mutation). Serum lipids were not affected by dietary intervention and cholestyramine treatment, so low‐density lipoprotein apheresis was scheduled to commence at the age of 4 y.

Conclusion: An early lipid profile determination should be performed in children with a family history of premature CHD, since the physical examination may be unremarkable even in cases of severe hyperlipidaemia during the first years of life.
Childhood sarcoidosis in Denmark 1979–1994: incidence, clinical features and laboratory results at presentation in 48 children
Authors: Hoffmann AL , Milman N , Byg K‐E
Published: August 2010

Aim: To describe the incidence, clinical presentation and paraclinical findings in childhood sarcoidosis in Denmark, 1979–1994. Methods: Patients (n= 5536) with a diagnosis of sarcoidosis were drawn from the nationwide Patient Registry; 81 patients were ±15 y of age. The diagnosis of sarcoidosis was reconfirmed in 48/81 (59%) patients. In 35/48 (73%) patients, diagnosis was verified by histology, and in 13 it was substantiated by paraclinical/clinical findings. Results: The series comprised 26 boys and 22 girls (male/female ratio 1.18). Median age at diagnosis was 13 y (range 0.7–15). In 1979–1994 the incidence was 0.29 per 100 000 person‐years ±15 y of age. The incidence was 0.06 in children ±4 y of age and increased gradually with age to 1.02 in children aged 14–15 y. General malaise, fever, weight loss, abdominal discomfort, respiratory symptoms, lymphadenopathy and central nervous system symptoms were common; 31% of patients had erythema nodosum, 12.5% sarcoid skin lesions, 25% uveitis/iridocyclitis and 4.2% sarcoid arthritis. Chest X‐rays were normal (stage 0) in 10% of patients, and showed pulmonary infiltrates stage I in 71%, stage II in 8.3% and stage III in 8.3%. Lung function tests were examined in 13 patients: 50% had decreased FEV1 and vital capacity, 80% decreased DLCO. Haemoglobin values were normal. Some patients had mild leukopenia, some moderate leukocytosis and a few had moderate eosinophilia. Erythrocyte sedimentation rate was elevated in 40% of the patients. Plasma calcium was elevated in 30% of the patients; 4 patients had severe hypercalcaemia and elevated plasma creatinine, and 1 patient had nephrocalcinosis. Serum angiotensin‐converting enzyme was elevated in 55% of the patients. Liver function tests were normal with no sarcoid hepatitis. Urinary examination (glucose, albumin, haemoglobin) was normal in 96% of the patients; the patient with nephrocalcinosis had albuminuria and haematuria.

Conclusion: The incidence of sarcoidosis in Danish children is low and increases with age. Sarcoidosis in young children may present clinical features that are different from the appearance of those in older children and often constitute a diagnostic challenge. In older children, the clinical appearance has many features in common with the presentation in adults.
One‐third of term babies after perinatal hypoxia–ischaemia have transient hearing impairment: dynamic change in hearing threshold during the neonatal period
Authors: Jiang ZD , Wang J , Brosi DM , Shao XM , Wilkinson AR
Published: August 2010

Aim: To examine the process of change in hearing threshold during the neonatal period after perinatal hypoxia‐ischaemia. Methods: The threshold of brainstem auditory evoked responses (BAER) was measured serially during the first month after birth in 92 term babies who suffered hypoxia‐ischaemia. Results: The mean BAER threshold in these babies was significantly increased on day 1 (ANOVA p < 0.001). The elevated threshold decreased progressively on days 3 and 5, but was still significantly higher than that in normal controls (p < 0.01). The elevation continuously decreased more slowly on days 10 and 15, and to a near normal level on day 30. Threshold elevation was seen in 31.7% of the babies on day 1, and 34.5% during the first three days. The rate of elevation decreased progressively thereafter. On day 30, 10.6% of the subjects still had increased thresholds. Moderate to severe elevation occurred mainly during the first week and severe elevation occurred predominately on day 1. Threshold elevation starting after days 3–5 is likely to be due to middle‐ear disorders. As a whole, during the first month, 44.6% (41/92) of the babies studied had threshold elevation. BAER threshold was correlated weakly with the stage of hypoxic‐ischaemic encephalopathy on days 1 and 3. The threshold was significantly higher in babies with severe encephalopathy than in those with mild or moderate encephalopathy during the first 3 d of life.

Conclusion: Hearing threshold is elevated in about one‐third of term babies after hypoxia‐ischaemia. The elevated threshold decreases progressively after birth, and returns to normal by one month in most babies. The threshold correlates weakly with the severity of encephalopathy.
Early motherhood and disruptive behaviour in the school‐age child
Authors: Trautmann‐Villalba P , Gerhold M , Laucht M , Schmidt MH
Published: August 2010

Aim: To determine the significance of young maternal age, family adversity and maternal behaviour during mother‐toddler interaction in the prediction of child disruptive behaviour at age eight. Methods: From an ongoing longitudinal study of infants at risk for later psychopathology (n= 362), 72 young mothers aged between 15 and 24 y (median 22 y) at first birth were compared with 197 primiparous older mothers ranging in age from 25 to 41 y (median 29 y). Family adversity at childbirth was assessed using a modified version of Rutter's Family Adversity Index (FAI) and measures of child disruptive behaviour at age eight were obtained using Achenbach's Teacher Report Form (TRF). An observational procedure was used to assess maternal behaviour during mother‐child interaction at the age of 2 y. Results: Young mothers encountered more adverse family characteristics and were more inadequate, restrictive and more negative during interaction with their toddlers. Their school‐aged children showed higher scores on all disruptive behaviour scales of the TRF. Hierarchical regression analyses revealed that family adversity and maternal behaviour during toddler interaction could account for most of the association between early motherhood and child disruptive behaviour.

Conclusion: The impact of young motherhood on child mental health is not confined to teenage mothers and is mainly attributed to psychosocial and interactional factors.
The Danish national study in infants with extremely low gestational age and birthweight (the ETFOL study): respiratory morbidity and outcome
Authors: Kamper J , Jørgensen N Feilberg , Jonsbo F , Pedersen‐Bjergaard L , Pryds O ,   the Danish ETFOL Study Group
Published: August 2010

Aim: To describe and analyse neonatal care, short and long‐term morbidity with special reference to ventilatory support and chronic lung disease (CLD) in a population‐based study. Methods: During 1994 and 1995 a prospective, nation‐wide, multicentre study was conducted, comprising 477 liveborn infants with gestational age (GA) >28 wk and/or birthweight >1000 g. Of these, 407 infants received active treatment. The ventilatory treatment was based on the principle of permissive hypercapnia and early nasal continuous positive airway pressure (NCPAP) supplemented with surfactant and ventilator therapy in case of CPAP failure. Results: Among actively treated infants 85% received CPAP and 23% mechanical ventilation from the first day of life. A total of 269 infants (56%) survived to discharge. Of these, 195 had a GA >28wk. One‐hundred and five survivors with GA >28 wk survived with NCPAP as sole respiratory support. In surviving infants, periventricular leucomalacia/intraventricular haemorrhage grade 3–4 was found in 10%, retinopathy of prematurity grade >2 in 4%, and oxygen requirement at 36 and 40 wk of postmenstrual age (CLD) in 16 and 5%, respectively. Three infants either died of CLD (n= 1) or required oxygen therapy beyond 43 wk of postmenstrual age. Logistic regression analysis showed significant associations between oxygen requirement at 40 wk and GA, septicaemia, mechanical ventilation, symptomatic patent ductus arteriosus and Clinical Risk Index for Babies score. Only the two last‐mentioned factors proved significant in infants with GA >28 wk. No infant died after discharge and 253 (94%) were followed up at 2 y of corrected age; one or more moderate to severe impairments were found in 66 (26%) of the examined children.

Conclusion: Ventilatory treatment in extremely premature and extremely low‐birthweight infants based on early NCPAP and permissive hypercapnia may result in comparable survival rates and sensorineural outcome; however, the incidence of CLD seems lower than that reported on conventional treatment.
Changes in parental risk behaviour after an information campaign against sudden infant death syndrome (SIDS) in Norway
Authors: Hill SAR , Hjelmeland B , Johannessen NM , Irgens LM , Skjærven R
Published: August 2010

Aim: To assess parental risk behaviour before and after a sudden infant death syndrome (SIDS) information campaign with special emphasis on associations with maternal age, education, marital status and birth order. Methods: Data from questionnaires sent to all mothers who gave birth in Norway during a period before the campaign were compared with corresponding data obtained after the campaign. Results: Prevalence of non‐supine sleeping position decreased from 33.7% to 13.6% while changes in smoking, non‐breastfeeding and co‐sleeping were disappointing. Risk factors were particularly prevalent in young mothers, but also in mothers with a minimum period of education, non‐cohabitation and at birth order 2+.

Conclusions: Non‐supine sleeping decreased to a level that has never been reported before. In future campaigns, subgroup‐specific measures may be needed.
Body mass index rebound and overweight at 8 years of age in hyperphenylalaninaemic children
Authors: Scaglioni S , Verduci E , Fiori L , Lammardo AM , Rossi S , Radaelli G , Riva E , Giovannini M
Published: August 2010

Aim: To evaluate whether the age at body mass index (BMI) rebound may be associated with overweight at age 8 y in hyperphenylalaninaemic (HPA) children. Methods: A longitudinal observational study including 97 HPA children born 1984–1993 and detected by the National Neonatal Screening programme. Children were followed up at the same institution and evaluated for dietary intakes and anthropometrical parameters from diagnosis up to the age of 8 y. Outcome measure was overweight at age 8 y, defined according to the International Obesity Task Force. The age at BMI rebound, BMI before and at rebound were considered as potential determinants. Familial overweight, breastfeeding and macronutrients intake at age 1 y were considered as confounders. Results: Mean (95% confidence interval [CI]) age at BMI rebound was 5.0 (4.7–5.3) y. At the age of 8 y, 24.7% (95% CI 16.3–33.1%) of children was overweight. Children overweight at the age of 8y exhibited earlier BMI rebound than non‐overweight children (mean difference [95% CI] —2.1 [‐2.8 to ‐1.4] y) and higher BMI from the age of 1 y (mean difference [95% CI] 1.2 [0.9–2.5] kg/m2) onward. Overweight was more likely in children with, rather than without, parental overweight (41.0% vs 19.8%). After adjustment for confounders, logistic analysis showed that earlier BMI rebound (odds ratio [OR] 2.4, 95% CI 1.2–4.8) and BMI at age 1 y (OR 2.3, 95%CI 1.1–4.98) were independently associated with overweight at the age of 8 y.

Conclusion: Within the population of this study, overweight at age 8 y was positively associated with early BMI rebound and BMI at age 1 y.
Extracorporeal life support for children with meningococcal septicaemia
Authors: Luyt DK , Pridgeon J , Brown J , Peek G , Firmin R , Pandya HC
Published: August 2010

Objective: To describe the short‐term outcome of children with meningococcal sepsis treated with extracorporeal membrane oxygenation (ECMO) in a single centre. Design: Retrospective analysis of case notes. Setting: The Heartlink ECMO Centre, Glenfield Hospital, Leicester. Patients: Eleven children (8 boys) out of a total caseload of 800 patients were treated for meningococcal sepsis with ECMO. Interventions: Extracorporeal membrane oxygenation. Results: All children with meningococcal sepsis treated with ECMO had a Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS) >12 (positive predictive risk of death of approximately 90%). Five children had adult respiratory distress syndrome (ARDS) and six had refractory shock with multi‐organ dysfunction syndrome (MODS) at presentation for ECMO. All five children in the ARDS group survived, four of five receiving veno‐venous (VV‐) ECMO therapy. In contrast, only one of six children with refractory shock with MODS survived, all of whom required veno‐arterial (VA‐) ECMO therapy.

Conclusions: Most children with meningococcal sepsis and severe ARDS can be successfully treated with VV‐ECMO. In contrast, children with refractory shock and MODS die despite treatment with VA‐ECMO. This report does not resolve whether ECMO therapy offers any advantage over conventional therapy in treating severe meningococcal sepsis.
Concentrations of IL‐10 in preterm human milk and in milk from mothers of infants with necrotizing enterocolitis
Authors: Fituch CC , Palkowetz KH , Goldman AS , Schanler RJ
Published: August 2010

Background: Despite the protective effects of human milk against necrotizing enterocolitis, the incidence is highest in the extremely premature infant, and only minimally decreased with feeding human milk. This suggests that certain protective agents may be lower in milk from mothers delivering extremely premature infants. The anti‐inflammatory cytokine IL‐10 was one possibility. Aim: We hypothesized that low concentrations of IL‐10 in preterm milk contribute to the development of necrotizing enterocolitis in extremely premature infants. Methods: IL‐10 in human milk collected at weeks 1, 2, and 4 postpartum was measured by ELISA in mothers of infants born extremely premature at 23–27 wk gestation (group EP), premature at 32–36 wk gestation (group P), and term at 38–42 wk gestation (group T). Single milk samples were collected from a separate group of mothers whose infants developed necrotizing enterocolitis. Results: There were no significant differences in concentrations of milk IL‐10 among groups EP, P, or T. Concentrations of IL‐10 declined as lactation progressed (p > 0.001). IL‐10 in milk was frequently undetected in all groups, but even more so in the milk of the group of women whose infants had necrotizing enterocolitis (86%) than in groups EP (40%) and P (27%) (p > 0.01).

Conclusion: IL‐10 was present in preterm milk from most women, and the concentrations in preterm and term milk were not significantly different. A paucity of IL‐10 in human milk was found in certain mothers in each group, especially in those whose infants developed necrotizing enterocolitis.
Migrant children—a challenge for European paediatricians
Authors: Hjern A , Bouvier P
Published: August 2010

Each year, tens of thousands of children seek asylum in Europe. Irregular immigration, family reunification programmes and labour migrants contribute additional large populations to the migrant scene in Europe. Paediatricians struggle to find solutions to their needs of health and medical care within different societal and political contexts on a common platform of children's rights and medical ethics.

Conclusions: Migrant children have important health and protection needs. Paediatricians can improve the health and well‐being of migrant children by assuring access to paediatric healthcare regardless of the child's legal status. Paediatricians can play an important role in advocating for migrant children in their local community, through concerted activities of national paediatric societies, and through the international paediatric community. National paediatric societies need to put migrant children high on their agenda in discussions with policy and decision makers. Initiatives are needed to create platforms within the international paediatric community where practical strategies to the multitude of issues touched upon by migrant children can be exchanged and international advocacy organized.