bluuebunny/crossref_metadata_2025 huggingface dataset:
Ten‐year follow‐up of children born before 29 gestational weeks: health, cognitive development, behaviour and school achievement
Authors: Stjernqvist K , Svenningsen NW
Published: August 2010

Since the mid‐1990s several studies have reported poor school performance in extremely preterm infants. The necessity to provide a full picture of the child's situation has been indicated. In a southern Swedish population 32 120 infants were born during the 2‐y period 1985‐1986. In total, 121 infants (0.4%) were reported liveborn before the 29th gestational wk and 12 (0.04%) were reported stillborn. Only 65 infants (50%) survived to the age of 10 y. The aim of this study was to evaluate the situation of extremely preterm (EPT) children at school, compared with that of full‐term (FT) control children, at the age of 10 y. Health, cognitive development, school achievement and behaviour were measured. Ninety‐two percent of the preterm children had no major neurological disability and most were in good health. The EPT children had an IQ of 90 ± 15 vs 106 ±15 (mean ± SD) for the FT children (p < 0.001), and on the test of Visual‐Motor Integration, the EPT children had 93.3 ± 12.2 vs 109.6 ± 14.2 for FT peers (p < 0.001). On both tests the differences between the groups corresponded to approximately one standard deviation. Thirty‐eight percent of the EPT children performed below grade level at school. Thirty‐two percent had general behavioural problems and 20% had attention deficit hyperactivity disorder, compared with 10% and 8%, respectively, in the FT group. EPT children require interventions to support their development and reduce behavioural problems. □Behaviour, development, extremely preterm, follow‐up, health, school achievement
Thyrotoxicosis in children: thirty years’experience
Authors: Raza J , Hindmarsh PC , Brook CGD
Published: August 2010

Optimal treatment for thyrotoxicosis remains controversial in adults, but more so in paediatric practice. We have conducted a retrospective review of the records of 76 paediatric patients seen between 1965 and 1995 to determine management practice and outcome of therapeutic interventions. Seventeen are currently on antithyroid drug (ATD) treatment, while four have had their care transferred. Of the remaining 55, 21 (38%) achieved long‐term remission with ATD alone following a mean treatment duration of 3.3 y (range 0.5—7 y). Block‐replacement (high dose of ATD with thyroxine replacement) was more convenient than the titration regimen (3.4 ± 0.3 visits to hospital per year versus 6.1 ± 0.4, p < 0.001). Surgery (subtotal/total thyroidectomy) was carried out in 27 patients, of whom 24 subsequently became hypothyroid and were treated with thyroxine. I131 was used successfully in six patients, two following surgery. ATD should remain the first‐line therapy; a block‐replacement regimen is more convenient. Surgery in a specialized centre carries a low risk. Caution should still be exercised in the use of I131 in young children. □Graves’disease, hyperthyroidism, radioactive iodine therapy, surgery, thyroid disease
Abnormal surfactant composition and activity in severe bronchiolitis
Authors: Skelton R , Holland P , Darowski M , Chetcuti PA , Morgan LW , Harwood JL
Published: August 2010

A prospective study of infants under 1 y of age, ventilated for severe viral bronchiolitis, was carried out in four paediatric intensive care units in order to study surfactant activity and composition in this condition. Lung lavage fluid from 24 infants with bronchiolitis, 19 with bronchiolitis and sepsis or cardiac failure and 12 controls were analysed by the “click test” for surfactant activity and for phospholipids. Surfactant activity was present in all controls, but in only 2 of the 24 infants with bronchiolitis alone. The presence of phosphatidylglycerol correlated perfectly with the click test, suggesting that reduced activity is due to changes in surfactant lipid composition. In those with bronchiolitis plus coexisting disease, surfactant activity and phosphatidylglycerol were absent in only half. Surfactant activity and phosphatidylglycerol re‐appeared by extubation. Severe viral bronchiolitis is associated with an absence of surfactant activity and PG, which resolves by clinical recovery. Infants with coexisting conditions are not always surfactant deficient. Surfactant administration is likely to be beneficial, but requires a selective approach. □Bronchiolitis, lung surfactant, phosphatidylglycerol
Cardiac output and ductal reopening during phototherapy in preterm infants
Authors: Benders MJNL , Van Bel F , Van de Bor M
Published: August 2010

Left ventricular output (LVO), left pulmonary artery blood flow (LPA) and patency of the ductus arteriosus (PDA) were studied with 2D/pulsed Doppler ultrasound before, during and after phototherapy treatment in 27 preterm infants (gestational age ≤ 32 wk), who were exposed for a minimum of 12 h to phototherapy for non‐haemolytic hyperbilirubinemia. In 14 infants (52%) the ductus arteriosus reopened during phototherapy, but ductal patency was not of haemodynamic importance. LVO initially decreased in preterm infants in whom the ductus did not reopen. From 12 h until discontinuation of phototherapy, LVO and LPA were higher than before phototherapy in all infants. After withdrawal of phototherapy, LVO and LPA returned to pre‐phototherapy values. □Cardiac output, patent ductus arteriosus, phototherapy, preterm
Preventing acute respiratory infections and diarrhoea in child care centres
Authors: Barros AJD , Ross DA , Fonseca WVC , Williams LA , Moreira‐Filho DC
Published: August 2010

This study was designed to explore the physical characteristics and child care practices of child care centres as potential risk factors for respiratory infections and diarrhoea in children 3–35 mo of age. A dynamic cohort averaging 667 children from 40 child care centres in Campinas (Brazil) was followed up for 8 mo. Direct structured observations were made to collect information on the centres' physical structure, child activities and child care practices. Despite their good infrastructures, hand washing in the centres was infrequent, and nearly 30% of diaper changes were unhygienic. Risk factors for diarrhoea included the presence of flies during meals, infrequent child hand washing before meals, and infrequent child hand washing after defecation, with relative risks of 1.33, 1.73 and 1.63, respectively. There was 33% less diarrhoea in classes where soap was frequently used during diapering. Contrary to our hypotheses, ventilation, group size and child density were not associated with respiratory infections, as was the case for most other factors studied. Only mixing of groups and a larger classroom area were found to be negatively associated with lower and upper respiratory infections, respectively. The results indicate that improving hygiene practices is the only intervention in child care centre characteristics with good potential to reduce diarrhoea among attendees. For respiratory infections, no modifiable characteristic with intervention potential was identified.
Infant and maternal factors in the development of breastfeeding behaviour and breastfeeding outcome in preterm infants
Authors: Nyqvist K Hedberg , Ewald U
Published: August 2010

A wide range in incidence of breastfeeding has been reported in preterm infants. The aim of this study was to explore the influence of infant and maternal factors on the development of preterm infants' breastfeeding behaviour and breastfeeding outcome. The sample consisted of 71 preterm infants born after a gestation of 26‐35 wk. A descriptive, prospective design was used, with direct behavioural observation as data collection method, based on mothers' assessments according to the Preterm Infant Breastfeeding Behavior Scale (PIBBS), in which higher scores indicate higher competence. Multiple regression analyses revealed that variables associated with efficient infant performance included higher birthweight, less need of ventilator and oxygen treatment, higher haemoglobin level, absence of bottle‐feeding, no need of apnoea treatment with Theophylline, and no suspicion of infection. A short gestation was associated with high PIBBS scores during weeks 32–37. Maternal characteristics associated with higher infant competence were breastfeeding experience and low educational level. Fifty‐seven infants were discharged with full breastfeeding and 10 infants with partial breastfeeding. Infants with a short gestation period achieved full breastfeeding at low postmenstrual and high postnatal age. Infants with Theophylline treatment, low haemoglobin level, and a longer period of separation from their mothers established full breastfeeding at higher postmenstrual and postnatal age. In conclusion, low gestational age at birth was associated with early emergence of efficient breastfeeding behaviour and a high incidence of full breastfeeding.
Familial and environmental influences on bone growth from 11–17 years
Authors: Magarey AM , Boulton TJC , Chatterton BE , Schultz C , Nordin BEC
Published: August 2010

The influences on bone growth of familial factors, nutrition and physical activity are described in a cohort of 108 children (56M, 52F). Distal forearm bone width, mineral content and volumetric density, anthropometry, pubertal status, nutritional intake and physical activity were measured at ages 11, 13, 15 and 17 y. Parental forearm bone status was also determined. Both mothers' and fathers' bone variables were significant predictors of the respective children's bone variables, but heritability estimates were greater between mothers and their children than between fathers and their children. By age 17 y boys had attained 101%, 85% and 89% of their fathers' height, bone mineral content and volumetric density, respectively; girls had attained 103%, 95% and 98% of their mothers' height, bone mineral content and volumetric density, respectively. There were no consistent associations among nutrient variables and bone status or rate of change in bone status. However, there was a significantly greater increase in bone mineral content and density from 11–17 y in those girls with consistently high calcium intake. There were no significant correlations between physical activity and bone values or rate of change of bone values. Age, gender, pubertal status, height, weight and parental bone values accounted for 80%, 71% and 49% of the variance of bone mineral content, bone width and volumetric density, respectively and 52%, 55% and 58% respectively of the variance of change in these variables. After age, gender, sexual maturity and body size, heritability accounts for the greatest variance in bone values through adolescence.
Bacterial flora of the lower respiratory tract in children with bronchial asthma
Authors: Fayon M , Just J , Thien H Vu , Chiba T , Pascual L , Sandouk G , Grimfeld A
Published: August 2010

The aims of this retrospective study were to (i) determine the risk of contamination of lower respiratory tract samples obtained during fiberoscopy in children; (ii) determine the incidence and profile of the bacterial flora of the lower respiratory tract in a selected group of asthmatic children at high risk for bacterial infection; and (iii) identify risk markers for such findings. In 29 asthmatic children, comparison of bacterial cultures of specimens obtained from the upper and lower respiratory tracts showed that contamination was a possibility in only 3.4% (1/29) of cases. The results from bacterial samples obtained via flexible bronchoscopy in a further 273 consecutively investigated physician‐diagnosed asthmatic children were analysed. Patients were selected for bronchoscopy if they had severe chronic asthma or in order to exclude other diseases able to provoke wheezing. Their mean (SD) and median ages were 32.2 (38.3) and 17.5 mo, respectively. The incidence of positive bacterial cultures was 12.1% (33/273 patients). Bacterial flora included H. influenzae (39.5%, 15/38), B. catarrhalis (23.7%, 9/38), Neisseria species (7.9%, 3/38), M. pneumoniae (7.9%, 3/38), P. non‐aeruginosa (5.3%, 2/38) and P. aeruginosa (2.6%, 1/38). No clinical or radiological markers were significantly associated with lower respiratory tract bacterial infection. Large quantities of bacteria were present in the lower respiratory tracts of a substantial number of children (1/8) in this selected group of asthmatics. For the moment, however, the clinical implications of this finding remain unclear.
Smith‐Lemli‐Opitz syndrome: in vivo and in vitro study of testicular function in a prepubertal patient with ambiguous genitalia
Authors: Berensztein E , Torrado M , Belgorosky A , Rivarola M
Published: August 2010

The pathogenesis of the development of ambiguous genitalia reported in some 46,XY patients with Smith‐Lemli‐Opitz syndrome is not understood. Presumably, it is related to the 7‐dehydrocholes‐terol reductase deficiency present in these patients. In this study we have evaluated testicular function, both in vivo and in vitro, in a 46,XY patient with ambiguous genitalia, reared as a girl. The diagnosis was based on clinical features, low serum cholesterol and high serum 7‐dehydrocholesterol levels. Serum hormone values, determined during the first month of age, showed normal basal testosterone (1.95 ng/ml), LH (0.91 U/l) and FSH (2.51 U/l). However, serum testosterone did not increase after hCG administration (1.98 ng/ml). On the other hand, the patient had a positive biological response to exogenous testosterone (decrease in sex hormone‐binding globulin serum levels). She was orchidectomized at the age of 33 mo. Testicular cells were dispersed and maintained in culture for 6 d. These cells showed a very good capacity to secrete testosterone into the culture medium (X ± SD, 26.1 ± 11.7 vs. 4.36 ± 1.70pmol/106 cells/24 h in a control group of testicular cells prepared from testes collected at necropsy). The patient's cells failed to respond to LH stimulation (18.6 ± 4.0 pmol/10s cells/24 h), although they did respond to other stimuli. It is concluded that the severe cholesterol deficiency of this patient did not impair the capacity of the testes to synthesize testosterone. However, the LH/hCG receptor or its subsequent message was activated neither in vivo nor in vitro. This finding suggests that the foetal testes might have failed to respond to placental hCG at the time of male external genital differentiation. This failure could have been responsible for the ambiguous genitalia present in this patient.
Non‐nutritive sucking in full‐term and preterm infants studied at term conceptional age
Authors: Lundqvist C , Hafström M
Published: August 2010

Non‐nutritive sucking (NNS) patterns in full‐term newborn and preterm infants were studied at term conceptional age. The preterm group showed a distinct NNS pattern with a higher frequency and lower amplitude. In the preterm group, gender differences were observed, the girls having higher frequency and larger amplitude. The full‐term infants' NNS patterns were also related to pacifier use during early childhood. Experience, gender, maturity and level of tension are suggested as explanatory factors for differences in NNS patterns.
Bone mineral density in patients with phenylketonuria
Authors: Zeman J , Bayer M , Štěpán J
Published: August 2010

Dual energy X‐ray absorptiometry was performed in 44 patients with phenylketonuria (PKU) aged 6–29 y. The phenylalanine‐restricted diet was based on a low‐protein diet in combination with phenylalanine‐free amino acid mixtures and phenylalanine‐low casein hydrolysate in 32 patients. The 10 oldest patients were supplemented only with casein hydrolysate, and the youngest child received only the amino acid mixture. One patient has recently come off the diet. Bone mineral density (BMD) of the lumbar spine and total BMD were measured and expressed as Z‐score, i.e. the difference between the BMD of the patient and the average BMD of sex‐ and age‐matched controls divided by the standard deviation of the control group. Normal BMD was found in 24 (54%) patients. Lumbar spine BMD was decreased in 20 patients and total BMD was decreased in 14 patients. Z‐scores of −1 to −2.5 were found in 14 patients (32%) and Z‐scores of < 2.5 in 6 patients (14%). No significant correlation was found between total or lumbar spine BMD and daily intake of phenylalanine from natural sources in the low‐protein diet or the amount of phenylalanine‐free amino acid mixtures per kg of body weight. A significant negative correlation was observed between both total and lumbar spine BMD Z‐scores and the amount of casein hydrolysate supplementation per kg of body weight (r=‐0.45; y = 0.07‐0.69x; p < 0.01). Long‐lasting dietary restriction in patients with PKU may increase the risk of late complications of dietary therapy, such as osteoporosis or trace element deficiency.
Incidence of ceftriaxone‐associated gallbladder pseudolithiasis
Authors: Papadopoulou F , Efremidis S , Karyda S , Badouraki M , Karatza E , Panteliadis C , Malaka K
Published: August 2010

We prospectively evaluated the incidence of gallbladder pseudolithiasis in children treated with high doses of ceftriaxone for a variety of serious infections. We also monitored the time interval needed for this phenomenon to develop and resolve completely after initiation and cessation of treatment, respectively. Included in this study are 44 children treated with ceftriaxone 100 mg/kg/d divided into 2 equal intravenous doses and followed by serial abdominal sonography. Eleven children developed pseudolithiasis of gallbladder 2‐9 d after initiation of ceftriaxone therapy. Six children (54.5%) developed this complication within the first 3 d. Lithiasis completely resolved 8–23 d after the end of treatment. In conclusion, pseudolithiasis of the gallbladder developed in 25% of sick children and completely resolved in all patients. Early development of this complication was not exceptional. It occurred in more than half of these children.
First week kangaroo care in sick very preterm infants
Authors: Törnhage C‐J , Stuge E , Lindberg T , Serenius F
Published: August 2010

The aim was to investigate whether kangaroo care (KC) with and without nasogastric tube feeding (NG) is tolerated by sick preterm infants during the first week of life. Seventeen infants with current or resolving illness received 1 h of KC. The study patients were originally recruited for a study on the response of intestinal peptides to feeding during KC. Median gestational age was 28 wk and median birthweight 1238 g. During KC, eight infants received NG. During KC, oxygen requirements were unchanged or decreased in 15 infants and increased in 2 infants. Changes in arterial blood gases, transcutaneous pO2/pCO2, heart rate and temperature were minimal. One episode of apnoea occurred. In conclusion, KC was well tolerated, as was NG, during KC.
Bone growth from 11 to 17 years: relationship to growth, gender and changes with pubertal status including timing of menarche
Authors: Magarey AM , Boulton TJC , Chatterton BE , Schultz C , Nordin BEC , Cockington RA
Published: August 2010

The tempo and change in bone growth during puberty in relation to physical growth is described in a cohort of 56 boys and 52 girls. Distal forearm bone width, mineral content and volumetric density, anthropometry and pubertal status were measured at ages 11, 13, 15 and 17 y, and bone age at 17 y. Bone width and mineral content increased independently with age for each pubertal stage. Volumetric density fell during early puberty and then increased rapidly. Maximal increase of all bone variables occurred earlier in girls than in boys and earliest for bone width, then mineral content, then density. In girls most change occurred in the 12 mo before and after menarche. The degree of tracking was similar to that for height. Bone growth followed physical growth but at a slower tempo. By age 17 y boys had attained 86% of the reference adult bone mineral content and volumetric density; girls had attained 93% of the reference adult bone mineral content and 94% of volumetric density. Those skeletally mature at 17 y had greater mineral content and volumetric density. To maximize peak bone mass, modifiable environmental factors should be optimized before the onset of puberty and be maintained throughout this period of rapid growth and beyond attainment of sexual maturity.
Eating disorders in adolescent girls with insulin‐dependent diabetes mellitus: a population‐based case‐control study
Authors: Engström I , Kroon M , Arvidsson C‐G , Segnestam K , Snellman K , Åman J
Published: August 2010

In this study the prevalence of eating disorders in a population‐based cohort of 89 female patients with type 1 diabetes, 14–18 y of age, was compared with that in age‐matched healthy controls. Of all diabetic girls in the study area, 92% participated in the study. The majority were treated with multiple insulin injections and the mean HbA1c of the participants was 8.4%. On average, diabetic girls were 6.8 kg heavier than the controls. A two‐stage design was used. The first consisted of a validated self‐report questionnaire, the Eating Disorder Inventory (EDI). Girls who had high scores were then interviewed about eating habits and mental health using a semistructured interview, the BAB‐T (Assessment of Anorexia‐Bulimia ‐ Teenager version). No cases of anorexia or bulimia nervosa were found, but 15 diabetic patients (16.9%) compared with 2 control girls (2.2%), p < 0.01, had disturbed eating behaviour according to the questionnaire. In 6 of these 15 diabetic girls an eating disorder was confirmed at the interview, mainly binge eating and self‐induced vomiting. None of the control girls showed an eating disorder. Overweight diabetic girls scored higher on EDI than non‐overweight diabetic girls (x2= 4.9; p= 0.038). No relationships were found between EDI scores and metabolic control (HbA1c), dose of insulin, frequency of hypoglycaemia or diabetic ketoacidosis.
Breastfeeding patterns in exclusively breastfed infants: a longitudinal prospective study in Uppsala, Sweden
Authors: Hörnell A , Aarts C , Kylberg E , Hofvander Y , Gebre‐Medhin M
Published: August 2010

Exclusive breastfeeding was studied among 506 infants in Uppsala, Sweden, based on daily recordings during the first 6 mo. The mothers had previously breastfed at least one infant for at least 4 mo. Most of the mothers considered that they breastfed on demand. Wide variations in breastfeeding frequency and suckling duration were found both between different infants and in the individual infant over time. At 2 wk, the mean frequency of daytime feeds (based on one 13‐d record) between different infants ranged from 2.9 to 10.8 and night‐time feeds from 1.0 to 5.1. The daytime suckling duration (based on one 24‐h record) ranged from 20 min to 4h 35min and night‐time duration from 0 to 2h 8 min. At any given age, a maximum of only 2% of the infants were not breastfed during the night. At 4 mo, 95% of the infants were breastfeeding and 40% were exclusively breastfed at this age. Longer breastfeeding duration and longer duration of exclusive breastfeeding were both associated with higher frequency of breastfeeds, longer breastfeeding of the previous child and higher education. No gender differences were found. Maternal smoking was associated with shorter duration of exclusive breastfeeding, and pacifier use was associated with shorter duration of both exclusive breastfeeding and total breastfeeding. This study confirms that every mother‐infant pair needs to be understood as a unique dyad throughout lactation. These data demonstrate a wide range of patterns among women who are exclusively breastfeeding and indicate that it would be inappropriate to put pressure on individual families to adopt preconceived patterns of infant feeding.
Long‐chain 3‐hydroxyacyl‐CoA dehydrogenase deficiency
Authors: Tyni T , Pihko H
Published: August 2010

Long‐chain 3‐hydroxyacyl‐CoA dehydrogenase (LCHAD) deficiency is one of the recently discovered defects of mitochondrial fatty acid β‐oxidation. As a group, the β‐oxidation defects are among the most common inherited metabolic disorders, and LCHAD deficiency appears to be the most frequently diagnosed β‐oxidation defect in Finland. In the vast majority of patients, LCHAD deficiency is caused by a common autosomal recessive mutation G1528C. Like several β‐oxidation defects, it presents during infancy with hypoglycemic coma, hepatic steatosis, and hypocarnitinemia. Other manifestations are cardiomyopathy and rhabdomyolysis, which are frequent in defects of long‐chain fatty acid oxidation. In addition, LCHAD deficiency has specific features, namely peripheral neuropathy and chorioretinopathy. Female carriers of LCHAD deficiency are prone to have preeclampsia‐related pregnancy complications. Diagnosis is suggested by 3‐hydroxylated acylcarnitine species in blood and the definitive diagnosis can be made by measuring intermediates of fatty acid β‐oxidation in fibroblasts or by detecting disease causing mutations. Analysis of the frequency of the G1528C mutation in Finland revealed carrier frequency of 1:240. Because of therapeutic and prenatal diagnostic opportunities in LCHAD deficiency, it is important to recognize this severe disorder early in its course.
Urinary tract infections in children below two years of age: a quality assurance project in Sweden
Authors: Hansson S , Bollgren I , Esbjörner E , Jakobsson B , Mårild S ,   On behalf of the Swedish Pediatric Nephrology Association, Göteborg
Published: August 2010

The objective of this study was to evaluate the basis for diagnosis and assessment of children <2 y of age with urinary tract infections (UTI) and to describe their subsequent management as currently practised in Sweden. The study was a prospective, multicentre project as part of a programme for quality assurance. A total of 2309 children (1111M, 1198F) was studied during a 2‐y period. Of the population at risk, 1.6% of both boys and girls were diagnosed with a UTI. This represents a minimum figure. Suprapubic bladder aspiration was mainly used during the first year of life, with the highest frequency in the youngest infants. Adhesive bags were used in half of the children, and the frequency increased with age. Imaging of the urinary tract was performed in 97% of the children. Vesicoureteric reflux was the most common finding, occurring in 36% of the girls and 24% of the boys. The presence of dilatation of the upper urinary tract correlated significantly to the presence and grade of reflux. Initial intravenous therapy was given to 31% of the children and long‐term antibacterial prophylaxis to 20%. Major differences were found between centres in diagnostic rate, urine sampling technique and the use of parenteral therapy. In conclusion, this study showed a high diagnostic rate of urinary infections in children below 2 y of age. The urine sampling technique was optimal (suprapubic aspiration) in half of the infants, but less reliable in the children above 1 y of age. The frequency of imaging investigations of the urinary tract was high. The strategies for diagnosis and treatment varied considerably among centres.
A clinical and neurophysiological study of scorpion envenomation in Assiut, Upper Egypt
Authors: Farghly WMA , Ali FA
Published: August 2010

Scorpion envenomation (SE) represents an agonizing problem in many countries, especially in rural areas. This clinical and neurophysiological study aimed to determine the relative frequency of scorpion envenomation in the Assiut area, in Upper Egypt. Full clinical evaluation was carried out for all children ≤18y of age included in the study. Electroencephalography (EEG), electromyography (EMG) and motor conduction velocity measurements were carried out for a variable number of children. SE was recorded in 302 cases per year in this area. Of these, 78.5% were ≤18y of age. SE occurred most commonly during the summer months. Clinical evaluation revealed that SE results in marked autonomic manifestations, principally sinus tachycardia (78.1%), vomiting (70.5%) and hyperthermia (53.2%). It also results in many neuropsychiatric manifestations, such as agitation and restlessness (17.7%) and disturbance of consciousness (8.0%). Electroencephalographic study of 184 cases of SE in paediatric patients aged ≤18y revealed abnormalities in 77.7%. Study of mean distal latency and motor conduction velocity revealed that patients had a significantly shorter distal latency and a more rapid motor conduction velocity compared with the control group. This was true for both the inflicted limb and the contralateral limb. Most of the complications of SE are due to irritability of the central and peripheral nervous systems.
Factors affecting diabetes mellitus onset in cystic fibrosis: evidence from a 10‐year follow‐up study
Authors: Cucinotta D , De Luca F , Scoglio R , Lombardo F , Sferlazzas C , Di Benedetto A , Magazzu G , Raimondo G , Arrigo T
Published: August 2010

This study reports the results of genotype characterization and of a 10‐y prospective evaluation of clinical status, glucose tolerance and insulin secretion in 28 originally normoglycaemic patients with cystic fibrosis (CF). The aim of the study was to assess whether any genetic, clinical or metabolic parameters could identify in advance those patients at risk of developing diabetes mellitus over time. During the follow‐up 42.8% of patients became diabetic. Neither gender, age nor clinical parameters were significantly different at entry in the patients who eventually developed diabetes compared with those who did not. Insulin secretion during oral glucose tolerance tests (OGTT) deteriorated over time in both groups, whereas a progressive deterioration of glucose tolerance was only evident in the patients who developed diabetes and increased baseline glucose areas were the only predictive parameter of diabetes onset. Genotype analysis revealed significant differences between patients with and without diabetes: ΔF508 homozygosis was more frequent in the first group and N1303K mutation in the second group. In conclusion, in CF: (i) increased glucose areas during OGTT and deterioration of glucose tolerance over time can predict the evolution towards diabetes; and (ii) ΔF508 homozygosis may predispose to the risk of diabetes, whilst N1303K mutation seems to play a protective role.
Factors associated with initiation and duration of breastfeeding in Italy
Authors: Riva E , Banderali G , Agostoni C , Silano M , Radaelli G , Giovannini M
Published: August 2010

To evaluate factors associated with initiation and duration of breastfeeding in Italy, 1601 (73%) respondents among 2192 randomly selected mothers were interviewed within 1 mo of delivery. Mothers who started breastfeeding (85%) were followed‐up for 12 mo. A compliance rate of 100% was obtained. At multiple logistic regression analysis, mother having been breastfed herself (p<0.01), nursing guidance in the maternity ward (p= 0.01) and higher social class (p= 0.03) were positively associated with initiation of breastfeeding. We found that 42%, 19%, 10% and 4% mothers were still breastfeeding at 3, 6, 9 and 12 mo after delivery, respectively. Cox multiple regression analysis showed a negative association between duration of breastfeeding and pacifier use (p<0.01), and a positive association with a higher level of maternal education (p= 0.04). Formula supplementation in the maternity ward (given to 30% of infants) was associated with a shorter duration of exclusive breastfeeding (p = 0.03). Mothers need support with breastfeeding, particularly those from lower social backgrounds and with lower levels of education. Early use of the pacifier should be discouraged.
Factors affecting maternal anxiety about child rearing in Japanese mothers
Authors: Akazawa K , Kinukawa N , Shippey F , Gondo K , Hara T , Nose Y
Published: August 2010

In order to determine the factors causing anxiety in raising young children, data were collected from questionnaires completed by 1164 mothers of 3‐y‐old children at a standardized baby checkup. Factors concerning demographic characteristics, delivery and child rearing practice were used in multivariate logistic regression analysis. Stepwise logistic regression analysis showed that mothers rearing first children and toddlers who were susceptible to common illnesses were likely to worry. Improvements in the child rearing environment are needed.
Treatment of severely diseased newborns: a survey of attitudes among Danish physicians
Authors: Norup M
Published: August 2010

In order to describe the attitudes towards treatment of severely diseased newborns a questionnaire presenting four fictive situations concerning infants with myelomeningocele, trisomy 13, Down's syndrome and epidermolysis bullosa lethalis was mailed to all physicians employed at obstetric or paediatric departments in Denmark. The questionnaire was designed in two versions, differing as regards the parents'situation and attitude towards treatment in two of the situations. Each version was sent to half of the sample. Of 954 questionnaires 664 (69.6%) were completed and returned. The parents'situation and attitude towards treatment played a role in forming the treatment choice to a significant proportion of the respondents, although the majority seemed to form their decisions independently of this factor. In the situations presenting the infants with myelomeningocele and Down's syndrome there was controversy concerning the level of active treatment, while only a minority would provide active treatment in the two other situations. In the case of epidermolysis bullosa lethalis most respondents would provide morphine in doses that could unintentionally hasten death, while few were in favour of legalizing active euthanasia.
Unmasking anti‐endomysial antibodies in coeliac subjects positive for anti‐smooth muscle antibodies
Authors: Lasagni D , Ferrari R , Lapini M
Published: August 2010

Anti‐endomysial antibodies assayed by indirect immunofluorescence presently represent the most advanced in vitro method for diagnosing coeliac disease. While testing the serum of patients affected by coeliac disease for anti‐endomysial antibodies, we noticed in some samples the presence of anti‐smooth muscle antibodies. This led us to the hypothesis that anti‐smooth muscle antibodies might mask the presence of anti‐endomysial antibodies. The aim of our research was to develop a method that could confirm our hypothesis. Here we show that the AEA response can be effectively unmasked by increasingly diluting anti‐smooth muscle antibodies‐positive serum.
Long‐term neuropsychological sequelae of early‐treated congenital hypothyroidism: effects in adolescence
Authors: Rovet JF
Published: August 2010

A cohort of over 100 children with congenital hypothyroidism (CH) detected via newborn screening was followed regularly throughout childhood and into adolescence. They were studied using a variety of different tests as part of three consecutive research components: semiannual/ annual psychological assessments using age‐appropriate intelligence tests (phase I), detailed psychoeducational evaluations in grades 3 and 6 (phase II) and a thorough neuropsychological evaluation during adolescence (phase III). Controls for phase I were siblings and for phase II, classmates and siblings. Phase III controls were drawn from a larger control pool and were individually matched with each CH case for age and gender. The results showed that although the CH group was intellectually functioning well within the normal range by adolescence, the children were performing significantly below expectation. Longitudinal analyses showed significant declines in IQ with age, signifying that the CH group was failing to make the same age‐related gains as controls. Children with CH showed significantly poorer performance in visuospatial, language and fine motor areas as well as selective attention and memory deficits. At school, they were initially below par in arithmetic but were able to catch up by grade 6; however, their teachers reported that they were not performing as well as controls in the classroom and they demonstrated more difficulty with more complex school subjects such as science and social studies. Correlational analyses indicated different manifestations of early hypothyroidism versus later treatment factors, suggesting that while some effects can be improved by better treatment and management approaches, others caused by prenatal and perinatal thyroid hormone insufficiency may persist.
Prophylactic intermittent treatment with inhaled corticosteroids of asthma exacerbations due to airway infections in toddlers
Authors: Svedmyr J , Nyberg E , Thunqvist P , Åsbrink‐Nilsson E , Hedlin G
Published: August 2010

The aim of this study was to investigate whether budesonide, for 10 d, administered at the first sign of an upper respiratory tract infection, could reduce asthma symptoms in 1‐3‐y‐old children with asthma during infections. The primary efficacy variable was symptom scores. The study had a multicentre, randomized, double‐blind, placebo‐controlled design with parallel groups. Fifty‐five children with a mean age of 26 months received either budesonide or placebo via a spacer with a facemask. Each child was monitored for 1 y. Budesonide was given 400 μg q.i.d. for the first 3 d and b.i.d. for 7 d. Symptoms (cough, wheeze, noisy breathing and breathlessness) were scored (0‐3) daily by the parents. Asthma symptom scores were lower in children treated with budesonide than in those given placebo. The effect was most pronounced for cough and noisy breathing, but it did not affect the need for hospital care. In conclusion, treatment with budesonide, started at the first sign of a respiratory infection, reduced asthma symptoms in toddlers with episodic asthma.
Growth and weight gain in children with vesicoureteral reflux receiving medical versus surgical treatment: 10‐year results of a prospective, randomized study
Authors: Wingen A‐M , Koskimies O , Olbing H , Seppänen J , Tamminen‐Möbius T
Published: August 2010

In children with vesicoureteral reflux (VUR) and urinary tract infection, retardation of growth and weight gain at the time of diagnosis and catch‐up growth during follow‐up, mostly after operating for VUR, have been reported. A controlled trial comparing the effect on growth of surgical treatment and long‐term prophylactic antibiotic treatment has not been reported previously. Between 1980 and 1985, 306 children younger than 11 y with non‐obstructive grade III or IV VUR, with a history of symptomatic urinary tract infection, were randomly allocated to surgical or medical treatment. Of these, 236 were followed for 10 y, 118 randomized to surgical treatment (mean age at entry 3.5 ± 2.3 y) and 118 to medical treatment (mean age at entry 3.8 ± 2.5 y). All children had renal function and blood pressure in the normal range. Body height, measured at start and after 1, 5 and 10 y, was transformed to standard deviation score of height for chronological age (SDSH‐CA) and body weight to percentage of ideal body weight for height (%IBW). The evolution of SDSH‐CA and %IBW was similar in both treatment groups (SDSH‐CA: surgical: start, 0.23 ± 1.4; 10 y, 0.40 ± 1.0; medical: start, 0.14 ± 1.2; 10 y, 0.44 ± 1.2; %IBW: surgical: start, 99 ± 9%; 10 y, 107 ± 14%; medical: start, 98 ± 10%; 10 y, 105 ± 16%). While children starting the study below the age of 3 y (SDSH‐CA 0.55 ± 1.34) started significantly taller than those older than 3 y (SDSH‐CA −0.1 ± 1.39), the young ones demonstrated a significant drop in SDSH‐CA during the 1st year (SDSH‐CA 0.19 ± 1.23), which was regained up to the 10th year (SDSH‐CA 0.6 ± 1.13), and the older ones steadily gained height up to an SDSH‐CA of 0.28 ± 1.05 at 10 y. During all of the study period, treatment protocol, grade of VUR, renal parenchymal scars at entrance and urinary tract infections did not influence growth and weight gain. Age at entry and gender were the only significant correlates with growth and weight gain.
Nebulization of drugs in a nasal CPAP system
Authors: Smedsaas‐Löfvenberg A , Nilsson K , Moa G , Axelsson I
Published: August 2010

Aerosolized drugs have been used in infants for the treatment of respiratory distress syndrome and bronchopulmonary dysplasia (β‐agonists, steroids and surfactant) and bronchiolitis due to respiratory syncytial virus (epinephrine and ribavirin). Controlled clinical trials have, however, produced conflicting results, probably due in part to problems with the transportation of the aerosol from the nebulizer to the bronchioli. We have modified a nasal continuous positive airway pressure (CPAP) system permitting an aerosol to flow through a canal to the nasal prongs and into the airways of the infant. It has been used successfully for the administration of epinephrine, salbutamol, budesonide, acetylcysteine, natural surfactant and ribavirin to sick infants. The modified nasal CPAP system is a simple, safe, cost‐efficient and baby‐friendly system for respiratory support and drug treatment, which can be used in future trials of aerosolized drugs.
Babies, brains and culture: optimizing neurodevelopment on the savanna
Authors: DeVries MW
Published: August 2010

Cross‐cultural child development research has demonstrated the influence of infant experience as well as constitutional, neurodevelopmental influences in infant outcomes. African infant precocity found in a number of studies is examined in the light of developmental models and in the context of the enriched child‐rearing environment of pre‐industrial societies. Examples are drawn from fieldwork in East Africa that demonstrate the different contributions of pregnancy, nutrition, early learning and cultural factors on developmental outcomes. The multiple enhancing infant rearing and nutritional factors are postulated to optimize the rate of neuro‐development thereby contributing to psychomotor precocity.
The Adolescence Scale (AS‐ICSM)
Authors: Kaiser J , Gruzelier JH
Published: August 2010

Neurodevelopmental theories of psychosis, and schizophrenia in particular, have led to renewed interest in the relationships between brain maturation, adult personality and timing of puberty. Here we present a brief Adolescence Scale (AS‐ICSM) for the retrospective assessment of puberty milestones. The recommended version comprises one item for females, three for males and one common to both. An original version of five items was administered to 318 young adults. We found good internal consistencies of Cronbach's alpha = 0.87 for females and 0.83 for males, having excluded an item assessing timing of growth spurt. These findings show that the AS‐ICSM is a reliable and economic tool for research into the concomitants of early and late puberty.
Factors controlling the bacterial colonization of the intestine in breastfed infants
Authors: Orrhage K , Nord CE
Published: August 2010

This article summarizes the published data on the intestinal microflora in breastfed infants published during the last 15 y. Enterobacteria and enterococci are found in high numbers in most infants during the first week of life. Bifidobacteria and Bacteroides spp. are found in increasing numbers at the following weeks. The intestinal microflora in breastfed infants can also be followed by different biochemical parameters. Acetic acid is found in higher concentrations in breastfed than in formula‐fed infants. Degradation of mucin starts later in breastfed than in formula‐fed infants. The conversion of cholesterol to coprostanol is also delayed by breastfeeding. Geographical differences in the composition of the intestinal microflora in infants have been reported, i.e. enterobacteria, enterococci, bifidobacteria, lactobacilli and bacteroides show different occurrences in developed and developing countries. There are minor differences in the infant's intestinal microflora due to breastfeeding or/and formula feeding.
Dietary nucleotides: effects on the immune and gastrointestinal systems
Authors: Carver JD
Published: August 2010

Nucleotides (NT) and their related metabolic products play key roles in many biological processes. NT can be synthesized endogenously and thus are not considered essential nutrients. Studies have demonstrated, however, that dietary NT can have beneficial effects; the term “conditionally essential” has been used to describe their role in human nutrition. These nutrients may become essential when the endogenous supply is insufficient for normal function, even though their absence from the diet does not lead to a classic clinical deficiency syndrome. Most dietary NT are rapidly metabolized and excreted. However, some are incorporated into tissues, particularly at younger ages and with fasting. Under conditions of limited NT intake, rapid growth or certain disease states, dietary NT may spare the cost ofde novoNT synthesis and optimize the function of rapidly dividing tissues such as those of the gastrointestinal and immune systems. Animals fed NT‐supplemented versus non‐NT supplemented diets have enhanced gastrointestinal growth and maturation, and improved recovery following small and large bowel injury. Indices of humoral and cellular immunity are enhanced, and survival rates are higher following infection with pathogens. Infants receive NT in human milk, where they are present as nucleic acids, nucleosides, nucleotides and related metabolic products. The NT content of human milk is significantly higher than most cow's milk‐based infant formulae. Dietary NT are reported to enhance the gastrointestinal and immune systems of formula‐fed infants. Infants fed NT‐supplemented versus non‐supplemented formula have a lower incidence of diarrhea, higher antibody titers followingHaemophilus influenzaetype b vaccination and higher natural killer cell activity. These data suggest that human milk NT may contribute to the superior clinical performance of the breastfed infant.
Diagnosis of vesico‐ureteric reflux
Authors: Hellström M , Jacobsson B
Published: August 2010

The demonstration and grading of reflux is crucial in examination and follow‐up of any child with upper urinary tract infection. A variety of factors can influence the occurrence of reflux, e.g. race, genetics, state of maturation of the ureterovesical valve, diuresis, infection and bladder dysfunction, including obstruction and neurogenic disorders. Even when reflux is investigated under strictly standardized conditions, two consecutive bladder fillings frequently show different grades of reflux. Voiding cystourethrography is, to date, the only method with a generally accepted, well‐defined grading of reflux. It also allows detection of intrarenal reflux and anatomical and functional information about the bladder and urethra that is unobtainable by other methods. It is therefore usually considered the method of choice. Radionuclide cystography and, possibly, contrast enhanced ultrasonography can be complementary to voiding cystourethrography, but mainly for postoperative follow‐up and screening of siblings.
Bladder dysfunction in children with vesico‐ureteric reflux
Authors: Sillén U
Published: August 2010

Vesico‐ureteric reflux and non‐neurogenic bladder dysfunction are closely related, although a causal relationship has been established only for severe forms of detrusor‐sphincter dyscoordina‐tion. There are several urodynamic studies reporting high frequency of bladder instability and/or detrusor‐sphincter dyscoordination in children with reflux. The latter includes an element of functional outflow obstruction and is the most serious, since it accompanies kidney damage. When instability is the only urodynamic abnormality damage is absent. There are indications that treatment of bladder dysfunction increases spontaneous resolution of reflux and, furthermore, that bladder dysfunction is a negative prognostic factor following antireflux surgery. Recently also, gross reflux in infant boys was seen to associate with bladder dysfunction in addition to earlier finding of congenital malformation of the ureterovesical junction. However, no comparisons have emerged on the outcome following treatment of bladder dysfunction and following observation only. In conclusion, children with reflux on chemoprophylaxis prior to reimplantation must always be assessed for bladder dysfunction. This is especially important when there are recurrent urinary tract infections.