bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of maternal anxiety following neonatal screening and investigation for occult spinal dysraphism
Authors: Gibson PJ , Steptoe A , Hall DMB
Published: January 2008

The objective was to determine maternal anxiety and attitudes associated with a programme of neonatal screening and investigation for occult spinal dysraphism. Questionnaires were completed after diagnostic investigation (time 1) and 6 months later (time 2) by 83 mothers of babies with possible markers of occult spinal dysraphism who were normal on spinal ultrasound. Outcome measures were: attitudes to the programme; maternal adjustment and attitudes to the baby; the State‐Trait Anxiety Inventory. Fifty‐four other postnatal mothers formed the comparison group for maternal adjustment. No significant differences were found between investigation group (time 1) and comparisons on measures of maternal adjustment. Anxious mothers gave more negative responses to some maternal adjustment items but not to attitudes to the programme. Mean state anxiety at time 1 (33.66) and time 2 (33.69) and mean trait anxiety (36.23) were not higher than in mothers of normal babies. It can be concluded that a programme of investigation for neonatal abnormalities that pays attention to detail need not cause excessive maternal anxiety. However, some mothers remain anxious even after receiving normal results. Anxiety can be assessed during appraisal of a new investigation programme, but refinements are needed.
Plasminogen activators and plasminogen activator inhibitors in plasma of premature and term newborns
Authors: åstedt B , Lindoff C
Published: January 2008

Objective: To compare the plasminogen activators (tPA, uPA) and their inhibitors (PAI‐1, PAI‐2) at different gestational ages, related to levels in women at term and non‐pregnant women. Methods: Blood samples were obtained by puncture of the umbilical cord vein, in gestational weeks 39–40 (n= 21), 30–32 (n= 15), and 27–29 (n= 9). Analyses of PA and PAI antigen concentrations and of PAI‐1 activity were performed. Results: The mean tPA antigen level in term newborn infants was 14.5 μg/l compared to the premature newborns (7.0 μg/l) women at term (7.5 μg/l) and non‐pregnant women (2.3 μg/l). PAI‐1 activity and PAI‐2 antigen concentrations were also higher in term newborn than in premature infants. Conclusions: The plasma levels of the plasminogen activators and inhibitors are higher in term newborn compared with premature newborn infants, reflecting maturation of protein synthesis.
Gastric outlet obstruction caused by prepyloric mucosal diaphragm mimicking duodenal ulcer: a case report
Authors: Nissan A , Seror D , Udassin R
Published: January 2008

An 11‐year‐old child was evaluated for chronic gastric obstruction with intermittent symptoms from the age of 11 months. An upper gastrointestinal series performed at the age of 11 months was interpreted as compatible with severe pyloric stenosis due to a duodenal ulcer, but no surgery was recommended. Several other UGIT series, and at least four endoscopies performed during the following years by experienced gastroenterologists in Israel and in the United States, failed to reveal the true nature of the gastric outlet obstruction. The patient was operated upon shortly after referral to our institute. Upon celiotomy, a congenital antral web was found, the excision of which resulted in long‐term relief of all symptoms. The differential diagnoses of childhood gastric outlet obstruction and the possible pitfalls in the diagnostic workup are discussed.
Variable effect of growth hormone on growth and final adult height in Scottish patients with Turner's syndrome
Authors: Chu CE , Paterson WF , Kelnar CJH , Smail PJ , Greene SA , Donaldson MDC
Published: January 2008

The aim of this work was to assess the outcome of recombinant growth hormone (rGH) therapy in a large unselected group (72) of patients with Turner's syndrome (TS), 26 of whom have reached final height. Growth data were collected from Scottish patients with TS and outcome was assessed in three ways: response to therapy in the first year, response in subsequent years and final height. Phenotypic, auxological, genetic and biochemical factors, all of which may have affected the first‐year response, were investigated. Fifty‐one percent of the cohort had a clinically “good” first‐year response to therapy and 49% had a “poor” response; a “good” response was defined as a change in the TS standard deviation score (SDS) of +0.5 or more and a “poor” response as a change in the TS SDS of less than +0.5. The percentage of children showing a positive change in TS SDS after 2, 3 and 4 years of therapy declined (88%, 78%, 41%). Mean (range) final height was 142.6 (133.4–153.6) cm, mean (range) pretreatment TS SDS was ‐0.27 (‐2.1 to +1.09) and mean (range) final TS SDS was ‐0.05 (‐1.4 to +1.59). Thirteen (50%) patients attained a final height that was greater than projected, eleven did not attain their projected final height and two achieved their exact projected final height. Short girls with TS appear to benefit more from rGH supplementation than tall girls, but otherwise there was no significant correlation between any of the parameters studied and the response to treatment. It is concluded that large‐scale prospective studies are still required to assess the impact of rGH on final height in TS and to identify factors responsible for the variability in response.
Effects of routinely given pethidine during labour on infants' developing breastfeeding behaviour. Effects of dose‐delivery time interval and various concentrations of pethidine/norpethidine in cord plasma
Authors: Nissen E , Widström A‐M , Lilja G , Matthiesen A‐S , Uvnäs‐Moberg K , Jacobsson G , Boréus LO
Published: January 2008

A standard dose of 100 mg of pethidine was given im to 13 healthy primiparae during labour. The aim of the study was to investigate whether developing breastfeeding behaviour in the newborn infant was associated with the dose‐delivery time interval (DDI) or with the plasma concentration of pethidine and norpethidine in mixed cord blood at birth. The DDI was found to be unevenly distributed with no pethidine exposures in the time interval 5.4‐8h. The material was therefore divided into a “short DDI” group (1.1–5.3h) and a “long DDI” group (8.1–9.9h). The infants in the “short DDI” group had a depressed sucking behaviour in 15–45 min of observation and a delayed initiation of lip and mouth movements when compared with the infants in the “long DDI” group. Six of the thirteen infants did not suck their mothers' breasts during the observation period. These infants had higher median plasma concentrations of pethidine at birth than the seven infants who did start sucking. No differences were found between the plasma levels of norpethidine and the behaviour. It was concluded that 100mg of pethidine im as an analgesic given under routine conditions may have unfavourable effects on infants' developing breastfeeding behaviour if the DDI is short.
Procalcitonin and C‐reactive protein levels in neonatal infections
Authors: Monneret G , Labaune JM , Isaac C , Bienvenu F , Putet G , Bienvenu J
Published: January 2008

In order to assess the potential of procalcitonin measurement in the management of neonatal sepsis, daily variations in serum procalcitonin (measured by an immunoluminometric assay) were evaluated in 94 control and infected newborn infants in comparison to C‐reactive protein (measured by an immunonephelometric method). High levels of procalcitonin correlated with bacterial invasion and showed no discrepancies with C‐reactive protein. Procalcitonin increased (up to 400 μg 1‐1) and returned to the normal range (< 0.1 m̈g1‐1) more quickly than C‐reactive protein, suggesting that procalcitonin may be an early marker of favourable outcome. Another finding is a significant procalcitonin peak on the first day of life in the control group, independent of any infectious stimulus. In conclusion, procalcitonin seems to be an interesting marker of neonatal sepsis but additional investigations are needed to understand better its mechanism of synthesis in order to determine its clinical usefulness.
Synthetic or natural surfactants
Authors: Halliday HL
Published: January 2008

Surfactant replacement therapy is one of the most studied interventions in neonatal medicine, with many thousands of infants having been enrolled in randomized clinical trials. It is clear that surfactant therapy reduces neonatal mortality and the risk of pulmonary air leaks in babies with or at risk of developing respiratory distress syndrome. Yet some doubts linger over other aspects of this therapy, despite it having been an acceptable and proven therapy for the past 7–10 years. As regards timing of treatment, the earlier the better, with true prophylaxis being reserved for babies of less than 28 weeks' gestation. Natural surfactant preparations containing surfactant proteins B and C act more rapidly than their synthetic protein‐free counterparts and probably also have a greater impact on reducing neonatal mortality and pulmonary air leaks. Fears raised about immunological effects, prion transmission and chemical contamination of natural surfactants have not been substantiated. Long‐term follow‐up studies do not show any differences in outcome between treated and non‐treated infants, except that the incidence and severity of retinopathy of prematurity might be reduced by treatment with natural surfactant. Further research is needed and this will include more detailed follow‐up studies, newer indications for surfactant therapy and the testing of newer preparations with synthetic peptides or protein analogues added.
Pharmacokinetics and protein binding of intravenous ibuprofen in the premature newborn infant
Authors: Aranda JV , Varvarigou A , Beharry K , Bansal R , Bardin C , Modanlou H , Papageorgiou A , Chemtob S
Published: January 2008

The elimination, disposition and protein binding of ibuprofen (IBU) in premature infants were studied for use in the prevention of intraventricular hemorrhage and closure of patent ductus arteriosus. The kinetic profile of i.v. IBU lysine (10 mg/kg bolus) given within the first 3 h after birth was studied in 21 premature neonates (mean birthweight = 944.7 g, range: 575–1450 g; gestational age: 26.8 weeks, range: 22–31 weeks). Blood samples (0.3 ml/sample) were obtained at time 0 and at 1, 3, 6, 12, 24, 48, and 72 h post‐dose for IBU by high‐performance liquid chromatography (HPLC). Kinetic analyses assumed applicability of one open‐compartment model and calculations from the model‐independent areas under the time concentration curve (AUC). Data (mean ± SEM) show that apparent volume of distribution (AVd) was 62.1 ± 3.9 ml/kg, plasma t1/2 beta was 30.5 ± 4.2 h, elimination rate constant (kel) was 0.032 ± 0.004 h‐1plasma clearance was 2.06 ± 0.33 ml/kg/h and plasma concentration (Cp) at 1 h was 180.6 ±11.1 mg/1. Gestational age and birthweight were not related to drug elimination. In 10 neonates, IBU maintenance dose of 5 mg/kg once daily on days 2 and 3 generated mean Cp of 116.6 ± 54.5 mg/1 and 113.6 ± 58.2mg/1, respectively. Protein binding by ultrafiltration and capillary electrophoresis showed that the percentage bound IBU was significantly lower in full term cord plasma (94.98 ± 0.39%, n= 26) compared to adult plasma protein (mean ± SE = 98.73 ± 0.31%, n= 8, p < 0.0001). Compared to data from adults and older children, IBU elimination is markedly prolonged in neonates and protein binding is slightly lower. Thus, investigational and clinical therapeutic regimens should be adjusted to account for decreased drug disposition to ensure safe and effective therapy.
Overdoses of pethidine given to two preterm neonates
Authors: Pokela M‐L
Published: January 2008

This paper reports two mechanically ventilated preterm babies who received overdoses of pethidine in the neonatal period. One of the neonates (gestational age 26 weeks, birthweight 1040 g) received repeated appropriate doses, which resulted in central nervous system irritability and convulsion due to accumulation of the drug and its metabolite, norpethidine. The other neonate (gestational age 27 weeks, birthweight 980 g) received a major (10‐fold) overdose with little clinical effect. These two cases indicate notable individual variability in the responses of babies to pethidine. This is typical of other opioids, too. Therefore, the dosing of opioids to neonates should be titrated individually, and the patients should be observed carefully.
Severe complex I deficiency in a case of neonatal‐onset lactic acidosis and fatal liver failure
Authors: Mazzella M , Cerone R , Bonacci W , Caruso U , Munnich A , Rustin P , Saudubray JM , Romano C , Serra G
Published: January 2008

We report a newborn admitted to our service on the 2nd day of life because of hypotonia and metabolic acidosis. A progressive hepatocellular dysfunction dominated the clinical picture and the patient died at 13 months of age because of severe hepatic failure. Persistent lactic acidosis, high ketone bodies levels and high‐normal lactate/pyruvate and 3‐hydroxybutyrate/acetoacetate molar ratios in plasma were found. Investigation of a liver biopsy revealed low activities of all the mitochondrial respiratory chain enzymes but in particular a marked decrease of complex I (NADH cytochrome c reductase) activity. All respiratory chain enzyme activities were normal in cultured skin fibroblasts. Mitochondrial DNA analysis failed to detect any major rearrangements. Although only a few cases have been reported so far, it is becoming clear that liver should be considered as one of the organs involved in oxidative phosphorylation disorders. The finding of unexplained progressive liver failure with poor neurological conditions, lactic acidaemia and ketonuria strongly warrants investigation for a respiratory chain disorder. Moreover, the finding of normal respiratory enzyme activities in a tissue other than liver does not rule out the existence of an oxidative phosphorylation disorder in patients with hepatocellular disease of unexplained origin.
Peak expiratory flow in healthy Turkish children
Authors: Hergüner MÖ , GüneşLer SK , AltintaşL DU , Alparslan ZN , Yilmaz M , Aksungur P
Published: January 2008

This study was conducted on 1359 healthy, non‐smoking Turkish children (727M, 632F) with a mean age of 11.7 ± 3.4 (6–17) years, in order to determine the normal values of peak expiratory flow (PEF) in Turkish children and to compare various peak‐flow meters (PEFMs). PEF values increased with age and height in boys and girls. The relative increase in boys was significantly higher at puberty (p < 0.01). The values of Turkish children were found to be similar to those of Europeans. The results obtained from the three PEFMs were closely correlated.
Increase of staphylococci in neonatal septicaemia: a fourteen‐year study
Authors: Källman J , Kihlström E , Sjöberg L , Schollin J
Published: January 2008

All cases of neonatal septicaemia during 1981‐94 were studied at Örebro Medical Centre Hospital, Sweden. One hundred and thirty‐two children fulfilled laboratory and clinical criteria for neonatal septicaemia and were included. Staphylococcus aureus (n= 41), Group B streptococcus (GBS) (n= 32) and coagulase‐negative staphylococci (CoNS) (n= 27) were the dominating aetiologies. The annual incidence of septicaemia increased significantly, from 2.3 cases during the first 7‐year period to 3.3 per 1000 live births during 1988‐94. This increase was caused by S. aureus and CoNS, which mainly affected premature children and had an onset more than 48 h after delivery. GBS, on the other hand, slightly decreased and affected full‐term children within 48 h. The overall mortality was 11%. CoNS isolated during the latter 7‐year period were more resistant to antibiotics than those isolated during 1981‐87; resistance to methicillin increased from 14 to 45% and to gentamicin from 0 to 20%. These changes in aetiology and antibiotic susceptibility should be considered when selecting antibiotic treatment in neonatal septicaemia.
Incidence of recurrent intussusception following barium versus air enema
Authors: Eshel G , Barr J , Heiman E , Bistritzer T , Broide E , Klin B , Aladjem M
Published: January 2008

The aim of this study was to determine whether using air enema for acute intussusception is related to a higher rate of recurrence than other methods of treatment. A 10‐y (1986‐95) retrospective study was performed in a university‐affiliated paediatric division. The overall recurrence rate for 97 patients with acute intussusception was 7.8% (10% of whom were treated non‐surgically). There were no recurrences following the surgical treatment. In matched groups of patients, no risk factors were found for recurrence following air vs barium enema.
Randomized trial of high nutrient density formula versus standard formula in chronic lung disease
Authors: Fewtrell MS , Adams C , Wilson DC , Cairns P , McClure G , Lucas A
Published: January 2008

To test the hypothesis that the nutrient intake and growth of infants with chronic lung disease would be improved by providing nutrients in more concentrated form, and that the lower volume would improve respiratory status, 60 preterm infants requiring supplemental oxygen at 28 days of age were randomly assigned a low‐density (24 kcal/oz) formula fed at 180 ml/kg/day, or a high‐density (30 kcal/oz) formula at 145 ml/kg/day. There was no difference in growth, respiratory outcome, oedema or diuretic requirement between dietary groups. Infants fed the high nutrient density formula had significantly greater total energy (143 vs 134 kcal/kg/day) and protein (3.9 vs 3.6g/kg/day) intakes, largely because the low‐density formula group did not achieve the designated 180 ml/kg/day. In conclusion, use of a high‐density formula in infants with chronic lung disease did not improve growth or respiratory outcome, despite a small increase in total energy and protein intake.
Comparison of total alkaline phosphatase and three assays for bone‐specific alkaline phosphatase in childhood and adolescence
Authors: Rauch F , Middelmann B , Cagnoli M , Keller KM , Schönau E
Published: January 2008

We compared serum levels of total alkaline phosphatase (TAP) and bone‐specific alkaline phosphatase (BAP) as determined by three different assays (lectin affinity electrophoresis, immunoradiometric assay, enzyme‐linked immunosorbent assay) in subjects aged 5–20 years suffering from X‐linked hypophosphatemic rickets (n= 14), chronic renal failure (n= 10) and chronic cholestatic liver disease (n= 16). Results were compared to controls of the same age and were expressed as standard deviation scores (SDS). TAP correlated significantly with BAP (r > 0.9 for each assay; p <0.001) in controls. In children with cholestatic diseases, TAP (median SDS + 2.0) was elevated, but BAP, as measured by the electrophoretic assay, was within the reference range for most patients (median SDS: ‐0.4; p= 0.003 for the difference between the median SDS of TAP and BAP). In contrast, results for BAP as determined by the two immunoassays were not significantly different from TAP in any of the three patient groups (p > 0.05 in each group for both assays). In this study, the two immunoassays did not have a detectable advantage over lectin affinity electrophoresis in the determination of BAP.
Pre‐ and postnatal medical care and risk of sudden infant death syndrome
Authors: Kohlendorfer U , Haberlandt E , Kiechl S , Sped W
Published: January 2008

The current study investigated whether sufficient attendance at prenatal and postnatal checks affects the risk of sudden infant death syndrome. A case‐control study in the Tyrol enrolled 99 infants with sudden infant death syndrome that occurred between 1984 and 1994, and 136 randomly selected control cases. The risk of sudden infant death syndrome was higher in infants whose mothers attended less than five antenatal health checks than in the group with at least five or more visits (OR 5.1; p < 0.01). Babies who received medical help beyond routine health controls had a lower risk than those who did not (OR 0.32; p < 0.001). These differences persisted when social and demographic variables (mother's age at delivery, educational level, marital status, parity and gestational age) were taken into account. Our study identified inadequate antenatal and postnatal care as a risk indicator for sudden infant death syndrome and as a potential target for further educational work. Clinical recommendations should await the results of further evaluations.
Plasma and tissue levels of lipids, fatty acids and plasma carnitine in neonates receiving a new fat emulsion
Authors: Magnusson G , Boberg M , Cederblad G , Meurling S
Published: January 2008

This study was undertaken to compare Intralipid® with a new fat emulsion containing gamma‐linolenic acid and carnitine, named Pediatric Fat Emulsion 4501, in neonates with regard to lipid and carnitine metabolism over a short period of total parenteral nutrition. There were 10 neonates in each group and they tolerated the total parenteral nutrition well. In spite of the gamma‐linolenic acid supplementation in the new emulsion, arachidonic acid decreased significantly in plasma lipid esters and adipose tissue in both groups after 5 d of treatment. Also, there was a decrease in plasma docosahexaenoic acid which was more pronounced in the treatment group. The relative percentage values of linoleic and linolenic acids in adipose tissue were increased, indicating that newborns have a rapid accretion of fatty acids. Plasma triglycerides were effectively cleared during the periods without fat infusion. In the group that received Pediatric Fat Emulsion 4501 the means of both free and total plasma carnitine concentrations increased significantly, whereas they tended to decrease in the Intralipid® group.
Neonatal hearing screening with an automated auditory brainstem response screener in the infant's home
Authors: Oudesluys‐Murphy AM , Harlaar J
Published: January 2008

Universal neonatal hearing screening is essential if all infants with congenital or perinatally acquired hearing impairment are to begin treatment before the age of 6 months to facilitate development of speech, language, communication and academic skills. Screening cannot always take place in hospital because of the increase in very short‐stay deliveries. Therefore screening in the home may be necessary to achieve a high level of screening. We describe a feasibility study with an automated auditory brainstem response (AABR) screener in the infant's home as part of the service offered by the Well Baby Clinics in the Netherlands. Of the 277 infants who completed the screening 266 had the result “pass”, 7 “refer” and 4 had inconclusive results. The mean time needed per screening was 18 min. This study shows that neonatal hearing screening by nurses using an AABR infant screener in the home is feasible.
Motor impairments in children with epilepsy treated with carbamazepine
Authors: Braathen G , von Bahr L , Theorell K
Published: January 2008

Nineteen children with epilepsy were tested on two occasions, first during treatment with carbamazepine (CBZ) and then 6 months later without treatment. Plasma drug concentrations were within the therapeutic limits in all children. The children were examined with a standardized test of gross‐ and fine‐ motor functions, the Bruininks‐Oseretsky test of motor proficiency. Significant improvements were found in response speed (p < 0.05), in composite fine‐motor tests (p < 0.01) and in the total test battery (p < 0.05) after the treatment had been withdrawn. A tendency to improvement was found in the fine‐motor subtest of upper limb coordination (p= 0.08). Another group of 12 children was tested twice during treatment with CBZ with an interval of 6 months. No difference was found in this group except for an impairment of the results in the subtest of visual‐motor control on the second test occasion (p= 0.05).
Thermal balance in term and preterm newborn infants nursed in an incubator equipped with a radiant heat source
Authors: Sjörs G , Hammarlund K , Sedin G
Published: January 2008

A radiant hood warmer, a device that heats the incubator roof independently of the incubator's main heat source, was used to study the thermal balance of 11 full term and 13 preterm (gestational age 25–34 weeks) infants exposed to an isolated elevation of incubator roof temperature at stable ambient air temperature and humidity. After initial measurements without active heating of the incubator roof, the hood warmer was set to 33°C, 36°C and finally (preterm infants only) to 39°C. At least 18 min of measurements with the infant asleep were made at each hood warmer setting. In the term infants an increase in roof temperature from 30.5°C to 35.6°C resulted in an increase in skin temperature from 35.4 to 35.9°C, and a decrease in radiative heat loss from 32.8 to 20.7 W/m2 exposed skin. In the preterm infants an increase in roof temperature from 31.0 to 38.4°C led to an increase in skin temperature from 35.7 to 36.3°C and a decrease in radiative heat loss from 34.1 to 13.0 W/m2 exposed skin. The increased inner roof surface temperature did not affect evaporative or convective heat loss, skin blood flow, respiratory water loss, oxygen consumption or transepidermal water loss in either group. Thus, at stable ambient air temperature and humidity, the increase in incubator roof temperature resulted in an increase in skin temperature and a decrease in radiative heat loss in both term and preterm infants.
Low density lipoprotein in neonates with high cord serum cholesterol levels
Authors: Sánchez‐Muniz FJ , Bastida S , Perea S , Cuesta C , Aragonés A
Published: January 2008

Differences in cord serum low density lipoprotein (LDL) composition between male and female neonates with normal or high (≥ 100 mg/dl or ≥ 2.59 mmol/1) serum cholesterol levels were studied in 548 full‐term newborn infants of the Toledo Study (Spain), where the absence of known perinatal factors that would alter lipid levels in cord blood was confirmed. The percentage of females with a high serum total cholesterol (TC) level was higher (p < 0.02) than that of males. ANOVA two‐way analysis shows significant interaction of gender and cholesterol level upon LDL‐cholesterol, triglycerides and LDL cholesterol/Apoprotein (Apo) B ratio. However, Apo B was higher in those neonates, both male and female, with high cholesterol levels. The LDL fraction carried about 55% of TC in females with high TC levels (HF), whereas it transported just 40% in males with high TC levels (HM). LDL appeared more enriched in cholesterol than in Apo B in HF than in HM (p < 0.01). An increased level of small LDL particles should be associated with the higher triglyceride level found amongst HM. Results in LDL composition suggest that metabolic gender‐related differences in infants with normal or high TC are presented at birth.
Keeping a cool head, post‐hypoxic hypothermia–an old idea revisited
Authors: Thoresen M. , Wyatt J.
Published: January 2008

Hypoxia‐ischaemia produces permanent brain damage by processes that continue for many hours after reoxygenation/reperfusion. This provides a window of opportunity for therapy aimed at preventing further loss of brain cells. Reducing brain temperature by 2–6°C for 3–72 h after reoxygenation/reperfusion has been shown to reduce brain damage by 25–80% in controlled trials with six different neonatal animal models of hypoxia‐ischaemia. No adverse effects from mild hypothermia have been documented. The mechanisms of protection are unknown but may include a reduction in extracellular excitotoxic amino acids, reduced nitric oxide synthesis and inhibition of apoptosis. Mild hypothermia is currently the most promising clinically feasible neural rescue therapy for full‐term infants at risk of developing hypoxic‐ischaemic encephalopathy, but clinical use must be restricted to approved trial protocols.
Evaporation rate and skin blood flow in full term infants nursed in a warm environment before and after feeding cold water
Authors: Ågren J. , Strömberg B. , Sedin G.
Published: January 2008

Earlier results have shown that some infants born by elective Caesarean section start to sweat in a warm environment while others do not, and that sweating can be inhibited by feeding cold glucose. To determine whether these earlier observations, indicating a difference in postnatal temperature adaptation, could be reproduced in vaginally born infants, we measured the rate of evaporation from the skin surface, body and skin temperatures from several sites, skin blood flow and respiratory rate in newborn infants nursed in a warm environment, before and after feeding cold water. In all infants the body and skin temperatures increased in the warm environment (p < 0. 01), with a decreasing difference between oesophageal and leg skin temperature (p < 0. 01). Visible sweating occurred in 9/14 infants at a rectal temperature of 37.5°C. In the infants who started to sweat, evaporation rate increased from 5.6 ± 2. 8 (SD) g/m2/h 15min before sweating to 15.7 ± 10.6 g/m2/h (p < 0.05) when sweat became visible and the infants were fed cold water. After feeding of cold water the evaporation rate decreased and within 10min returned to a value not significantly different from the pre‐sweating value. Interscapular skin blood flow had increased by 42% (p < 0. 01) at the time of sweating and decreased by 22% (p < 0. 01) after feeding cold water. In the infants who did not start to sweat, no increase in evaporation rate was noted and the changes in skin blood flow were not statistically significant. The infants who started to sweat did not differ from those who did not regarding maternal medication during delivery. We conclude that some, but not all, newborn infants start to sweat at a body temperature of 37.5°C. In the infants who start to sweat, sweating and an increase in skin blood flow can be inhibited by feeding cold water. There seem to be individual differences in the regulation of body temperature in newborn infants, possibly due to a delayed change in the central temperature set‐point in some infants.
Continuous mannose infusion in carbohydrate‐deficient glycoprotein syndrome type I
Authors: Mayatepek E. , Schröder M. , Kohlmüller D. , Bieger WP , Nützenadel W.
Published: January 2008

The effects on isoelectrofocusing patterns of serum glycoproteins were studied in a patient with CDG syndrome type I and phosphomannomutase deficiency during 3 weeks of continuous intravenous mannose infusion. Doses of 5. 7 g/kg/day led to stable serum mannose levels up to 2. 0 mmol/1 and were well tolerated without signs of liver or renal toxicity. While most of the pathological glycoprotein patterns, including α1‐antitrypsin, typical for CDG syndrome type I remained unchanged, mannose infusion led to a unique change of the isoelectrofocusing pattern of serum sialotransferrins with appearance of two extra bands after 3 weeks of treatment.
Loperamide test: a simple and highly specific screening test for hypercortisolism in children and adolescents
Authors: Buzi F. , Corna A. , Pilotta A. , Negrini F. , Lombardi A. , Re T. , Ambrosi B.
Published: January 2008

The overnight dexamethasone (DXM) test can give false‐positive results in a few conditions (e. g. stress, strenuous exercise, depression, anorexia, anxiety, anticonvulsive therapy) in diagnosing simple obesity and hypercortisolism (HC). The loperamide (LP; a peripheral opioid agonist) test has proven useful in such conditions in adults. Thirty‐one obese subj ects (age 10.0–19.7 y) were studied by both overnight DXM test and LP test (8 mg orally, samples for Cortisol at 0, 90, 150, 180 and 210 min) on 2 separate days. LP suppressed Cortisol (≤ 138 nmol 1‐1) at a dose of 0.1 mg kg‐1 bw (half the minimum recommended dose for the drug's antidiarrhoea effect) in 14 subjects who had normal urinary (< 4970nmol 1‐1) and serum (< 552nmol 1‐1) cortisol, in the absence of signs and symptoms of HC (group A). The DXM test failed to suppress cortisol in three subjects in group A, two of whom were on anticonvulsive treatment. The LP test suppressed cortisol in all of 13 subjects with elevated urinary and/or serum Cortisol and/or with signs or symptoms of HC (but in whom HC was subsequently excluded on clinical grounds) (group B), while the DXM test failed to suppress cortisol in three subjects of this group. One of these was under anticonvulsive treatment and one suffered from anxiety and depression. In four patients with Cushing's syndrome (group C) neither DXM nor LP could suppress Cortisol levels. Therefore, the sensitivity was 100% for both DXM and LP, while the specificity was 84% for DXM and 100% for LP. No side‐effects were observed with either drug. In conclusion, LP is a useful alternative to DXM in those particular conditions that can affect its specificity in children.
Soluble receptors to tumour necrosis factor and interleukin‐6 in urine during acute pyelonephritis
Authors: Tullus K. , Escobar‐Billing R. , Fituri O. , Lu Y. , Brauner A.
Published: January 2008

We compared the urinary concentrations of soluble TNF‐I (sTNF‐RI), TNF‐II receptors, and soluble IL‐6 receptor (sIL‐6R) standardized to urinary creatinine concentrations, in children with acute pyelonephritis, in children with non‐renal fever and in healthy controls. These levels were related to the acute inflammatory response in the kidneys and later renal scarring, as determined by acute and 1‐y follow‐up with 99mTC‐dimercaptosuccinic acid scintigraphy (DMSA). The concentrations of the soluble receptors were measured using enzyme immunoassay (EIA). The urinary levels of sTNF‐RI were significantly higher in children with acute pyelonephritis (median 1320 pg/mmol) than in children with non‐renal fever, children 6 weeks after acute pyelonephritis and healthy controls (873, 251 and 477 pg/μmol, respectively). Median sTNF‐RII urine levels were also higher in acute pyelonephritis (4123 p/μmol) than in the three control groups (2000, 964 and 1850 pg/μmol, respectively). In contrast, the highest urinary sIL‐6R concentrations were found in healthy children (median 420 pg/μmol). compared to those with acute pyelonephritis (235 pg/μmol), children with non‐renal fever and children 6 weeks after pyelonephritis (137 and 50 pg/μmol, respectively). No significant difference was found in any of the urinary soluble receptor levels in children with or without DMSA uptake defects at the acute or the 1‐y follow‐up scintigraphy. In conclusion, although the urinary soluble TNF receptor levels were higher during acute pyelonephritis, this observation was not useful for deciding which children needed follow‐up after acute pyelonephritis.
Sequelae of recurrent acute otitis media. Ten‐year follow‐up of a prospectively studied cohort of children
Authors: Ryding M. , Konradsson K. , Kalm O. , Prellner K.
Published: January 2008

In a cohort of 113 children prospectively followed from birth to the age of 3, two subgroups were discerned: one with recurrent acute otitis media (rAOM), the other subgroup with no AOM at all (“healthy” children). At further follow‐up at the age of 10, no child had AOM or secretory otitis media (SOM), but between 3 and 7 y of age the rAOM subgroup was characterized by a significantly higher incidence of AOM as well as protracted secretory otitis media (SOM) episodes than was the “healthy” subgroup. The two subgroups did not differ significantly in hearing‐thresholds at pure tone audiometry. After the age of 7, the incidence of AOM was the same in both groups. It is concluded that children with frequent AOM episodes before the age of 3 need long‐term follow‐up to school age. but seem not to be predisposed to chronic SOM.
Serum C‐reactive protein and C3 complement protein levels in severely malnourished Nigerian children with and without bacterial infections
Authors: Ekanem EE , Umotong AB , Raykundalia C. , Catty D.
Published: January 2008

Bacterial infections are the major determinants of fatality in severe protein‐energy malnutrition (PEM). Unfortunately, these infections are difficult to diagnose clinically. C‐reactive protein (CRP) levels were determined in 17 infected and 10 non‐infected Nigerian children with severe PEM and compared with age/ sex‐matched apparently healthy controls. The aim was to study the response of this acute phase protein to bacterial infections as well as to assess its value in the diagnosis of infections in severe PEM. C3 complement protein levels were also determined in the same group of subjects. The major organisms isolated in samples from these subjects were S. aureus and the coliforms. Mean CRP level in the non‐infected children with severe PEM was 13.8 ± 6.21 mg/1 and rose to 159.83 ± 124.07 mg/1 in the presence of infection. The mean value in healthy non‐infected controls was 2.01 ± 0.96 mg/1. The difference in the mean CRP levels between the infected and non‐infected PEM children was statistically significant at p < 0.01. The mean difference between the non‐infected and the control subjects was not significant. Using a diagnostic level of 20.00 mg/1 of CRP gave a sensitivity of 85.0% and a specificity of 80.0%. This CRP level is a useful index of bacterial infections in severe PEM. C3 complement protein was low in the non‐infected malnourished group, but rose significantly in the presence of infection to values similar to that of the healthy controls. C3 protein thus behaves as an acute phase reactant in the presence of infection in severe PEM, and does not appear to be consumed, probably due to a deficiency in the early components of the complement cascade. This suggests a role for C3 measurement in the monitoring of bacterial infections in severe PEM.
Treatment of acute diarrhoea in practice
Authors: Kaila M. , Onnela T. , Isolauri E.
Published: January 2008

The recommended treatment for acute diarrhoea includes oral rehydration and rapid refeeding is increasingly recommended. The objective of this study was to assess the home use of oral rehydration, and rehydration and realimentation in hospital. The parents of children (aged less than 4 y) with acute diarrhoea answered questions on supplementary fluids and diet during the current diarrhoea at home (n= 129). The admitted patients (n= 60) were weighed daily and food consumption was measured (consecutive 3‐d food record). Oral rehydration had been attempted in 67% of the children managed at the outpatient department and in 65% of those admitted. The total energy intake was on average 697 kcal (95% confidence interval 639–755), which is two‐thirds of that recommended for the age group. Oral rehydration has become accepted in the management of acute diarrhoea, while rapid realimentation is not yet equally endorsed.
Red blood cell glutathione and plasma sulfhydryls in chronic lung disease of the newborn
Authors: Moison RMW , Haasnoot AA , van Zoeren‐Grobben D. , Berger HM
Published: January 2008

We compared the postnatal changes (days 1–28) in red blood cell glutathione and plasma sulfhydryl content in preterm babies developing chronic lung disease (CLD, n= 13) to those in babies with respiratory distress syndrome (RDS, n= 13) and control babies (n= 21). There were no initial differences in these measurements between the three groups. However, on day 28 in CLD and RDS the red blood cell glutathione was decreased compared to the control babies (p < 0.05). In CLD, there was a significant correlation between reduced/oxidized glutathione and (i) maximal FiO2 (r= ‐0.69, p < 0.05) and (ii) minimal a/A ratio (r=+0.73, p < 0.005). On day 28, although the plasma sulfhydryl level did not differ between the groups, the sulfhydryl/total protein ratio was decreased in CLD (p < 0.05). The late decrease in both glutathione and sulfhydryl/total protein ratio in babies with CLD suggests that oxidative stress is still ongoing at 28 days after birth and that the antioxidant capacity of their blood is still diminished at this time.
Carbohydrate‐deficient transferrin in galactosaemia
Authors: Stibler H. , von Döbeln U. , Kristiansson B. , Guthenberg C.
Published: January 2008

Carbohydrate‐deficient isoforms of transferrin (CDT) were examined in Guthrie cards from patients with galactosaemia before and during dietary treatment for up to 9 y. In untreated patients the CDT values were elevated due to abnormal asialo‐ and/or disialotransferrin. During treatment, the CDT levels were normal except on a few temporary occasions. Galactose or its close metabolites did not inhibit two relevant glycosyltransferases in vitro, and their levels were not correlated to the CDT values. The transferrin isoform changes in untreated patients were similar to, but less pronounced than in CDG syndrome type I.
Inhaled budesonide reduces lung hyperinflation in children with asthma
Authors: şekerel BE , Tuncer A , Saraçlar Y , G Adahoǧ Lu
Published: January 2008

Previous studies have shown that asthmatics have hyperinflation as defined by larger total lung capacity. The present study was set up in order to document changes in asthma clinic, airway calibre, airway reactivity and lung volumes after budesonide treatment. After a 2‐week run‐in period, 28 children with moderate persistent asthma were treated in a double‐blind manner either with budesonide (0. 4 mg/day) or placebo for 8 weeks and, thereafter, all patients were treated with open‐label budesonide for a further 20 weeks. Symptoms, bronchodilator requirements and airway calibre improved significantly after 8 weeks of treatment (p < 0. 05 for each) and prolonged treatment did not cause any further improvement. Reduction in hyperreactivity was apparent only after 20–28 weeks of treatment. Total lung capacity decreased along with budesonide treatment in both groups suggesting that early introduction of an inhaled corticosteroid may be useful in the prevention of asthma‐related remodelling of the lung and thoracic cage.
Marfan syndrome and other systemic disorders with congenital ectopia lentis. A Danish national survey
Authors: Fuchs J
Published: January 2008

In order to elucidate demographic and nosologic characteristics of Marfan syndrome (MS) and other systemic disorders associated with congenital ectopia lentis (ECL) in Denmark, a register of affected persons was established in a nationwide retrospective study. Three hundred and forty patients with MS (180M, 160F) were registered. By January 1, 1993, theestimated prevalence rate ofMS was 4. 6/100 000. An estimated average birth rate of 0. 96/10 000 live born was found. The mean age at death was decreased (38 ± 18 y) mainly due to cardiovascular complications. Correspondingly, a median cumulative probability of survival of 57 y (males) and 58 y (females) was found. Only seven patients with ECL as manifestation of other systemic disorders were diagnosed in the material, i. e. three patients with homocystinuria, two patients with Weill‐Marchesani syndrome, and another 2 patients with sulphite oxidase deficiency. In a further 122 cases with ECL a nosologic diagnosis could not be established due to unavailable or insufficient information. This group may comprise patients with MS and other systemic disorders as well as patients with non‐systemic ECL. In retrospect, the differential diagnostic activity for patients with congenital ectopia lentis has been insufficient during the last few decades and a common protocol for diagnosis, control and treatment of ECL is needed.
Intestinal microflora of Estonian and Swedish infants
Authors: Sepp E , Julge K , Vasar M , Naaber P , Björksten B , Mikelsaar M
Published: January 2008

The intestinal microflora of 1‐y‐old healthy Estonian (n= 27) and Swedish infants (n= 29) was studied by quantitative culture of faecal samples. The major differences were high counts of lactobacilli and eubacteria in the former and increased numbers of Clostridia in the latter babies. Bifidobacteria and anaerobic cocci prevailed equally in both groups, while eubacteria and enterococci were the major microorganisms in many Estonian infants and bacteroides and Clostridia in many Swedish infants. The microflora of the Estonian infants was in many aspects similar to the flora prevailing in infants of western Europe in the 1960s. The results suggest a shift in the intestinal microflora among infants in western industrialized countries.
The value of immunoglobulin and complement levels in the early diagnosis of neonatal sepsis
Authors: Kalayci AG , Adam B , Yilmazer F , Uysal S , Gürses N
Published: January 2008

Serum IgG, IgGl, G2, G3, G4, IgM, C3c and C4 concentrations were measured in 24 term neonates with sepsis and 17 healthy normal neonates of similar age, sex and weight (control group). The serum IgG, IgG1, G2, G3, G4, IgM, C3c, and C4 levels were similar in the patients with sepsis and the control group (p > 0. 05). In the neonates with sepsis, serum IgG, G1, G2, IgM and C4 levels were not significantly different between the 1st and 10th days, while there were significant differences for IgG3, G4 and C3c (p < 0. 05). We conclude that the serum levels of IgG, IgG1, G2, G3, G4, IgM, C3c and C4 concentrations are of no value for the early diagnosis of neonatal sepsis.
Precocious pseudopuberty due to a granulosa cell tumour in a seven‐month‐old female
Authors: Cameron FJ , Scheimberg I , Stanhope R
Published: January 2008

We describe a juvenile granulosa cell tumour resulting in pseudopuberty in an infant female. The progression of the clinical signs of puberty were non‐consonant and the diagnosis was complicated by marginally elevated serum α‐fetoprotein levels. The histological appearance of the resected tumour and binding of MIC2 antibody to tumour cells confirmed the diagnosis.
The nature of interference potential of Kalmiaangustifolia
Authors: Inderjit Inderjit , Mallik A.U.
Published: January 2008

The nature of interference potential of Kalmiaangustifolia L., a boreal forest understorey shrub, was investigated in laboratory experiments. Organic and mineral soils, not previously associated with Kalmia, were amended with different quantities of its leaf litter and leaf litter leachates. The objectives of the study were (i) to determine changes in soil chemistry after amending with Kalmia and (ii) to determine the effect of amendment on growth of black spruce (Piceamariana (Mill.) BSP) seedlings. All soils were analyzed for pH, organic matter, PO4−, N, Ba, Cu, Zn, Fe, Mn, Ca, Na, K, Mg, Al, and total phenolics. Chemical characteristics of both organic and mineral soils were significantly changed. Water-soluble phenolics in one of the amended organic soils were significantly higher than in unamended organic soil. However, all of the amended mineral soils had significantly higher total phenolic contents than unamended control soils. A linear decrease in N content was observed in amended organic and mineral soils with increasing quantities of Kalmia leaf litter. Amended mineral soils had higher concentrations of Fe, Mn, Al, and PO4− than the control. We relate higher accumulations of PO4−, Fe, Mn, and Al in amended mineral soils to higher soil phenolic contents. Amendment of organic and mineral soils significantly reduced the root and shoot growth of black spruce. This study demonstrates that Kalmia has potential for nutrient interference and does not rule out allelopathic effects of Kalmia to black spruce seedling growth.