bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydrocephalus prevalence and outcome in a population‐based cohort of children born in 1989–1998
Authors: Persson Eva‐Kavin , Hagberg Gudrun , Uvebrant Paul
Published: August 2010

Aim: To determine the prevalence, aetiology and clinical outcome in children with surgically treated hydrocephalus. Methods: A population‐based study of all 208 liveborn children with hydrocephalus, 124 with infantile hydrocephalus and 84 with hydrocephalus associated with myelomeningocoele, born during 1989–1998 in western Sweden. Aetiological and clinical information was collected from records. Results: The prevalence of hydrocephalus was 0.82 per 1000 live births, 0.49 for children with infantile hydrocephalus and 0.33 for children with myelomeningocoele. The prevalence of infantile hydrocephalus decreased during the period from 0.55 to 0.43 per 1000. In this group, the aetiology was prenatal in 55% and peri‐postnatal in 44% of the children. The origin was perinatal haemorrhage in all cases born very preterm. The mortality rate was 5% for children with either infantile hydrocephalus or myelomeningocoele. Mental retardation, cerebral palsy and epilepsy were significantly more frequent in the group with infantile hydrocephalus: 46% vs 16%, 31% vs 4% and 31% vs 10%, respectively. All children with infantile hydrocephalus born very preterm had at least one of these impairments, as did 80% of those with overt hydrocephalus at birth.

Conclusion: A slightly decreasing trend for infantile hydrocephalus was observed during the 10‐y period. Children with infantile hydrocephalus had a worse outcome than those with myelomeningocoele. The need for neurosurgical revisions for two‐thirds of the children indicates the need for further development of prevention and treatment strategies.
Focus on neonatal resuscitation—NOW
Authors: Heinonen Kirsti
Published: August 2010

The paper by Saugstad et al. in this issue of Acta Paediatrica presents new and provocative data on the development of the child's physiological status during the first minutes of life. The data were extracted from the database of the Resair 2 study designed to investigate the outcome of resuscitation with air or 100% oxygen. The potential of these variables to predict the outcome of asphyxiated infants was evaluated.

Conclusion: The data—in spite of some technical limitations and lack of representative reference measurements—point out the potential value of sequential physiological observations in the early identification of newborn infants at risk of poor outcome, challenge the routine habit of giving ample oxygen to depressed neonates, and call for further studies.
Polyunsaturated fatty acids in plasma lipids of diabetic children during and after diabetic ketoacidosis
Authors: Decsi Tamás , Szabó Éva , Kozári Adrienn , Erhardt Éva , Marosvölgyi Tamás , Soltész Gyula
Published: August 2010

Background and aim: Previously we reported significantly higher plasma values of the essential fatty acids but significantly lower values of their longer‐chain metabolites in diabetic children than in healthy controls. Here, we report data on the acute effect of diabetic ketoacidosis (DKA) on the fatty acid composition of plasma lipids. Methods: Diabetic children (n=9; age: 16.1 [3.3] y; duration of diabetes: 5.0 [5.3.] y; daily insulin dose: 0.87 [0.66] unit/kg body weight/d; glycated haemoglobin: 13.4 [2.8] %; median [IQR]) were investigated at admission for DKA (during DKA) and at the end of the treatment of DKA (after DKA). Fatty acid composition of plasma lipid classes was determined by high‐resolution capillary gas‐liquid chromatography. Results: Blood glucose (27.0 [8.5] vs 6.5 [1.6] mmol/l), pH (7.28 [0.35] vs 7.36 [0.06]) and base excess (−8.9 [15.1] vs −2.2 [6.3] mmol/l) were grossly abnormal during but not after DKA. Values of linoleic acid were significantly lower after than during DKA (non‐esterifed fatty acids (NEFA): 15.55 [1.47] vs 12.27 [5.74] % wt/wt; triacylglycerols (TG): 20.84 [9.23] vs 17.40 [5.78]; p<0.05). In contrast, values of gamma‐linolenic acid (NEFA: 0.87 [0.54] vs 2.34 [1.85]; p<0.05) and arachidonic acid (TG: 1.37 [0.71] vs 1.74 [0.57]; p<0.05) were significantly lower during than after DKA. The product/substrate ratios for delta‐6 desaturation were significantly lower during than after DKA.

Conclusion: Successful treatment of diabetic ketoacidosis is associated with a significant increase of long‐chain polyunsaturated fatty acid values in blood plasma in diabetic children. This observation suggests that disturbances of essential fatty acid metabolism in diabetic children are related not only to diet but to hypoinsulinaemia as well.
Fast bedside measurement of blood count and C‐reactive protein in neonates with suspected late‐onset sepsis
Authors: Makhoul Imad R , Smolkin Tatiana , Zinder Oren , Diamond Eric , Tamir Ada , Sujov Polo
Published: August 2010

Conventional and fast complete blood count (CBC) and C‐reactive protein (CRP) measurements were compared in 56 neonates with suspected sepsis. Mean differences between pairs (conventional minus fast) of the corresponding CBC and CRP values were significant for the six CBC parameters tested (p<0.02), but not for CRP (p=0.18).

Conclusion: In neonatal sepsis, conventional and fast methods are comparable only for CRP but not for CBC variables.
Benign neonatal sleep myoclonus: An under‐recognized, non‐epileptic condition
Authors: Ramelli Gian Paolo , Sozzo Alessandra B , Vella Silvano , Bianchetti Mario G
Published: August 2010

During a 3‐y period 13 newborns were referred for investigation of jerks. The events were epileptic in six children. The diagnosis of benign neonatal sleep myoclonus was made in the remaining seven children.

Conclusion: Benign neonatal sleep myoclonus is an important neonatal entity that can be mistaken for epilepsy.
Parental assessment of developmental delay in children: Some limitations and hazards
Authors: Lagerberg Dagmar
Published: August 2010

According to a study published in the present issue of Acta Paediatrica, mothers' reports of developmental delays in children of preschool age were associated with socio‐economic factors.

Conclusion: For the present, developmental screening procedures using parental assessments cannot be considered evidence based. National health service systems ensuring preventive health care for all children, regardless of socio‐economic background, will form a more solid basis for early detection and treatment.
A single‐centre study can improve our knowledge of a rare disease! As exemplified by studies in Langerhans' cell histiocytosis
Authors: Donadieu Jean
Published: August 2010

The main contribution of this clinical study of Langerhans' cell histiocytosis (LCH) is that it provides information on the adult outcome of patients diagnosed during childhood.

Conclusion: The authors show that most patients, sometimes despite their sequelae, undertake higher education and live as independent adults. This study also offers evidence that some sequelae are due to radiotherapy, which should therefore be excluded from the treatment of LCH. The analysis of causes of death shows the important role of haematological dysfunction.
Assessment of left ventricular diastolic function by Doppler tissue imaging in children with end‐stage renal disease
Authors: Saygili Arda , Yildirim Selman Vefa , Cengiz Nurcan , Uslu Yasemin , Tokel Kürsat , Saatçi Ümit
Published: August 2010

Aim: To evaluate left ventricular (LV) diastolic function in children with end‐stage renal disease (ESRD) using conventional pulsed‐Doppler echocardiography and Doppler tissue imaging (DTI), and to compare the findings with these two modalities. Methods: Twenty‐four children with ESRD and 22 healthy age‐ and sex‐matched control subjects were assessed with conventional Doppler echocardiography and DTI. The scans of the renal disease patients were done after a dialysis session. Parameters related to LV systolic and diastolic function were compared in the ESRD and control groups. Results: The ESRD patients had lower mean mitral E/A ratio both according to conventional Doppler echocardiography and TDI than the control subjects. The ESRD group also had significantly longer isovolumetric relaxation time (116±31 ms vs 97±3.1 ms, respectively; p<0.001), and significantly longer deceleration time (235±44 ms vs 202±35 ms, respectively; p<0.01) than the control group.

Conclusion: DTI findings correlate well with conventional Doppler echocardiography findings. Children with ESRD show, after dialysis, echocardiographic signs of LV diastolic dysfunction.
Long‐term follow‐up of Langerhans cell histiocytosis: 39 years’ experience at a single centre
Authors: Bernstrand Cecilia , Sandstedt Bengt , Åhström Lars , Henter Jan‐Inge
Published: August 2010

Aim: To evaluate the long‐term outcome of Langerhans cell histiocytosis (LCH) in children. Methods: We re‐evaluated all children (<15 y old at diagnosis) treated at our unit in 1962–1989. Histopathology specimens were reviewed and verified for 49 patients. Forty patients underwent physical examination and laboratory tests, and 38 were subjected to imaging, at a median time of 16 y (range 5.5–33.5) after diagnosis. Results: Altogether, 5/49 (10%) children died, all with multi‐system disease and age <2 y at diagnosis. Age at diagnosis (p=0.001) and survival (p=0.014) for the 22 children with multi‐system disease was significantly lower compared with the 27 children with single‐system disease. The term “maximal extent of disease” was introduced since reactivation of LCH often tends to involve additional organs not previously affected by the disease. At follow‐up, late sequelae had developed in 17/40 (42%) patients, including diabetes insipidus in 6/40 (15%), CNS complications in at least 4/40 (10%) (3/16, 19%, of multi‐system patients) and late‐stage pulmonary disease in 4/38 (11%). Seven out of 21 (33%) of the patients with multi‐system disease were alive and healthy without sequelae at follow‐up, as compared to 16/24 (67%) of those with single‐system disease (p=0.026). Of 14 individuals 25 y at follow‐up, senior high school had been completed in 7/9 (78%) with single‐system and 1/5 (20%) with multi‐system disease (at maximal disease extent) (p=0.091).

Conclusion: Multi‐system LCH is associated not only with increased mortality but also pronounced propensity for severe late sequelae; 51% of the patients (multi‐system=33%, single‐system=67%) were alive without sequelae at follow‐up. Among multi‐system patients, at least 19% suffered CNS sequelae.
Screening for congenital cataracts: A cost‐consequence analysis of eye examination at maternity wards in comparison to well‐baby clinics
Authors: Magnusson Gunilla , Persson Ulf
Published: August 2010

Aim: To estimate, on a national basis in Sweden, the costs versus consequences of combined maternity ward and well‐baby clinic eye screening compared to well‐baby clinic screening alone. Methods: Two scenarios were created and compared regarding healthcare costs: visual acuity development and quality‐adjusted life‐years (QALYs). One scenario represented early management (combined maternity ward and well‐baby clinic screening); the other represented less early management (well‐baby clinic screening only). Each scenario was based on 100 000 births, and the healthcare costs were calculated from detection until age 18 y. All estimates of prevalence, visual outcome, postoperative complications and screening procedures were based on previous, recently published studies. Estimated costs were obtained from St. Erik's Eye Hospital in Stockholm and the University Hospital of Lund, at 2001 prices. Results: Total cost of the maternity ward/well‐baby clinic screening scenario was 7.9 million SEK, and that of the maternity ward screening scenario was 6.9 million SEK. The incremental cost‐effectiveness ratio was estimated at 234 000 SEK/QALY provided three more children per year were detected in Sweden by mandatory maternity ward/well‐baby clinic screening.

Conclusion: The incremental expense of introducing combined maternity ward/well‐baby clinic eye screening on a nationwide basis is cost effective and within acceptable levels of cost/QALY when compared with other widely accepted therapies across diverse medical specialties.
Measuring implementation progress in kangaroo mother care
Authors: Bergh Anne‐marie , Arsalo Irmeli , Malan Atties F , Patrick Mark , Pattinson Robert C , Phillips Noel
Published: August 2010

Aim:To describe the development and testing of a monitoring model with quantitative indicators or progress markers that could measure the progress of individual hospitals in the implementation of kangaroo mother care (KMC).Methods:Three qualitative data sets in the larger research programme on the implementation of KMC of the MRC Research Unit for Maternal and Infant Health Care Strategies in South Africa were used to develop a progress‐monitoring model and an accompanying instrument.Results:The model was conceptualized around three phases (pre‐implementation, implementation and institutionalization) and six constructs depicting progress (awareness, adopting the concept, mobilization of resources, evidence of practice, evidence of routine and integration, sustainable practice). For each construct, indicators were developed for which data could be collected by means of the monitoring instrument used in a walk‐through visit to a hospital. The instrument has been tested in 65 hospitals.

Conclusion:The progress‐monitoring model enables the quantification of individual hospitals' progress in the process of implementing KMC and an objective measurement of the effectiveness of different outreach strategies. The model also has potential to be adapted for measuring progress in other innovative healthcare interventions on a large scale.
Social inequalities in maternal opinion of child development in southern Brazil
Authors: de Lourdes Drachler Maria , Ganzo De Castro Aerts Denise , Mendonça De Souza Rosana , Carlos De Carvalho Leite José , Justo Giugliani Elsa , Marshall Tom
Published: August 2010

Aims and methods: Concurrent validity of maternal opinion of child development was estimated in a cross‐sectional, population‐based survey of 6–59‐mo children (n=3025), using a standard measure devised from the Denver Developmental Screening Test. Results: Sensitivity, specificity and negative predictive value increased with maternal education and family income. Positive predictive value was higher in low‐income families and children with impairments, low birthweight and long hospital stays.

Conclusion: Children at social and clinical risk should be assessed more carefully, even if maternal report is normal or advanced.
Does the choice of bottle nipple affect the oral feeding performance of very‐low‐birthweight (VLBW) infants?
Authors: Scheel C. E. , Schanler Richard J. , Lau Chantal
Published: August 2010

Background: There is a continuous debate regarding the best bottle nipple to be used to enhance the bottle‐feeding performance of a preterm infant. Aim: To verify that feeding performance can be improved by using the bottle nipple with the physical characteristics that enhance infants’ sucking skills. Methods: Ten “healthy” VLBW infants (941±273 g) were recruited. Feeding performance was monitored at two time periods, when taking 1–2 and 6–8 oral feedings/d. At each time and within 24 h, performance was monitored using three different bottle nipples offered in a randomized order. Rate of milk transfer (ml/min) was the primary outcome measure. The sucking skills monitored comprised stage of sucking, suction amplitude, and duration of the generated negative intraoral suction pressure. Results: At both times, infants demonstrated a similar rate of milk transfer among all three nipples. However, the stage of sucking, suction amplitude, and duration of the generated suction were significantly different between nipples at 1–2, but not 6–8 oral feedings/d.

Conclusion: We did not identify a particular bottle nipple that enhanced bottle feeding in healthy VLBW infants. Based on the notion that afferent sensory feedback may allow infants to adapt to changing conditions, we speculate that infants can modify their sucking skills in order to maintain a rate of milk transfer that is appropriate with the level of suck‐swallow‐breathe coordination achieved at a particular time. Therefore, it is proposed that caretakers should be more concerned over monitoring the coordination of suck‐swallow‐breathe than over the selection of bottle nipples.
Breastfeeding patterns, beliefs and attitudes among Kurdish mothers in Diyarbakir, Turkey
Authors: Saka Gunay , Ertem Meliksah , Musayeva Alida , Ceylan Ali , Kocturk Tahire
Published: August 2010

Aim: The aim was to rapidly assess existing breastfeeding patterns, beliefs and attitudes in the province of Diyarbakir, a socio‐economically disadvantaged region of Turkey. Methods: A cross‐sectional survey exploring demographic and breastfeeding patterns was carried out among 921 mothers with children 6–18 mo of age. Results were quantitatively analysed. Focus group interviews dealing with beliefs and attitudes were separately carried out among 107 mothers and analysed by qualitative content analysis. Results: Nearly all mothers had breastfed their infants at some time, but exclusive breastfeeding was rare. About 62.2% of the mothers had waited for at least 24 h before initiating breastfeeding. Almost half of the infants received sweetened water as a first feeding. There was agreement on the superiority of breastfeeding and awareness of its contraceptive effect. Early introduction of sugared water, water and supplementary feeds was considered desirable. Working in the fields and pregnancy were considered situations counteracting breastfeeding.

Conclusion: The attitude to breastfeeding was highly positive, but more information is needed to encourage the use of colostrum, discourage early supplementation and promote exclusive breastfeeding during the first 6 mo of life.
Cervicofacial nocardiosis in an immunocompetent child
Authors: Kumar T. Sathish , Xavier Scott Julius , Viswanathan Sugumaran , Agarwal Indira , Mohan Raj Promila , Lalitha Mukkai Kesavan
Published: August 2010

Nocardiosis occurs primarily as an opportunistic infection in an immunocompromised host. The infection may on rare occasion occur in a normal host confounding the diagnosis. It is also notably an uncommon infection in children. We report a 1‐y‐old girl with cervicofacial nocardial infection who presented with acute suppurative otitis media and lymphadenitis. This child did not have any predisposing risk factors for this infection and responded well to treatment with co‐trimoxazole and chloramphenicol. She is doing well on follow‐up.

Conclusion: Nocardiosis in an immunocompetent small child is reported.
Fabry disease and the heart: an overview of the natural history and the effect of enzyme replacement therapy
Authors: Shah JS , Elliott PM
Published: August 2010

Fabry disease is a genetic disorder caused by the deficiency of α‐galactosidase A, resulting in the lysosomal accumulation of glycosphingolipids. Fabry disease may result in cardiac, cerebral and renal complications. Cardiac abnormalities in patients with Fabry disease were first described in the 1960s. In the 1990s a form of Fabry disease confined to the heart was reported; however, this variant is extremely rare and a more appropriate concept is of cardiac predominance of the disease in some patients. Up to 60% of males with classic Fabry disease have cardiac abnormalities, including left ventricular hypertrophy, valvular dysfunction and conduction abnormalities. Recent data suggest that left ventricular mass and systolic function in patients with Fabry disease improve after 12 months of enzyme replacement therapy (ERT); however, many of the patients studied are relatively young and have mild cardiac abnormalities, suggesting that more research into the efficacy of ERT in older patients is necessary.

Conclusion: Cardiac manifestations are common in patients with Fabry disease and are not confined to a ‘cardiac variant’ of the disease.
Measurement of renal function in patients with Fabry disease
Authors: Kleinert J , Lorenz M , Hauser A ‐C , Becherer A , Staudenherz A , Födinger M , Sunder‐Plassmann G
Published: August 2010

Appropriate measurement of the glomerular filtration rate (GFR) is important for the assessment of renal function. This paper reviews the methods used to assess GFR in clinical trials of enzyme replacement therapy (ERT) in patients with Fabry disease, which include inulin clearance, 24‐hour creatinine clearance, chromium ethylene diamine tetraacetate (51Cr‐EDTA) clearance and cystatin C concentrations. GFR has also been estimated using calculations based on creatinine clearance (the Cockcroft–Gault formula) and the Modification of Diet in Renal Disease (MDRD) equation. Analysis of the results of these studies shows that there are striking discrepancies between estimated and measured GFR. For example, the MDRD equation overestimates GFR in patients with Fabry disease who have normal renal function. In addition, cystatin C has been shown to be of limited use for measuring renal function during ERT, because it is influenced by other factors such as age, gender and weight.

Conclusion: The use of exact methods, such as inulin clearance, 124I‐iothalamate, 99mTc‐DTPA, 51Cr‐EDTA and iohexol, appears to be mandatory for a robust evaluation of the effects of ERT on GFR in patients with Fabry disease.
What can cell biology tell us about heterogeneity in lysosomal storage diseases?
Authors: Gieselmann V
Published: August 2010

Lysosomal storage diseases are clinically heterogeneous with respect to their age of onset, progression of symptoms and the particular organs involved. Varying levels of residual enzyme activity, associated with different defective alleles that cause the respective diseases, are responsible in part for this clinical heterogeneity. In general, the higher the residual enzyme activity, the milder the phenotype. Enzyme activity in severe forms of disease is frequently zero, and in mild forms usually does not exceed approximately 5%. However, the correlation is not so strict as to allow prediction of the phenotype of individual patients. The molecular basis of the different levels of enzyme activity can only be revealed by biochemical investigations of the defective lysosomal proteins. Null alleles may be due to splice‐site mutations or deletions. In the case of missense mutations, enzymes frequently fold incorrectly and are retained in the endoplasmic reticulum and subsequently degraded. As these enzymes do not reach the lysosome, they do not provide any functional residual activity. Residual enzyme activity is only observed in cases where the defective enzyme reaches the lysosome and has retained enzymatic activity. Patients carrying the same mutant alleles still show considerable phenotypic variability due to modifying genes and epigenetic factors. None of these has so far been elucidated. However, there are some indications that differences in splicing‐factor machinery may influence the phenotypic expression of splice‐site mutations and that hormonal modulation of secondary microglial activation in lipidosis may also influence the disease course.

Conclusion: Phenotypic variability is a frequent phenomenon in lysosomal storage diseases. Residual enzyme activity has been identified as one of the factors influencing the clinical outcome of disease; however, it is obvious that other genetic and epigenetic factors also affect phenotypic variability, particularly in patients with late onset disease.
Action, prevention and epidemiology of paediatric obesity
Authors: Lissau Inge
Published: August 2010

The overall aim of this paper is to describe important issues regarding paediatric obesity as a public health problem. This paper focuses on actions taken, and on the prevalence of obesity in children, teens and adults in Denmark. In addition, the paper describes some important prevention studies, all of which are performed outside Denmark. Thus, this paper is not a classical review but rather a highlight of some aspects that the author finds important. The latest Danish national figures show a marked increase in the prevalence of obesity, especially among young men—a sevenfold increase from 1987 to 2000 (0.7 to 4.9%). Among young women aged 16–24, the increase is threefold in the same period. Among teens, the prevalence has increased by 2–3 times in recent decades. Nevertheless, compared to other European countries and the US, Denmark has a relatively low prevalence of obesity in adolescents. The present paper also covers results from prevention studies performed in both preschool and school settings. Some of these focus on the reduced intake of carbonated drinks, whereas others focus on both diet and physical exercise. Finally, this paper demonstrates that Denmark is at the forefront regarding a national action plan against obesity.

Conclusion: This paper highlights some important aspects of the epidemiology, prevention and actions in the field of paediatric obesity with special focus on Denmark.
PRESTO—Prevention Study of Obesity: A project to prevent obesity during childhood and adolescence
Authors: Dämon Sabine , Dietrich Sabine , Widhalm Kurt
Published: August 2010

The PRESTO project has been launched as a school‐oriented pilot project. The aims were to influence nutrition, physical activity and health. The intervention was performed by a multiprofessional team and covered 11 nutrition and health‐related sessions with 1 h per week in each class. The initial poor knowledge was improved significantly to the control group with better results in grammar schools compared to comprehensive schools. BMI was not improved in overweight children. However, this project could serve as a successful model in Austria.
Fetal nutrition: A review
Authors: Cetin Irene , Alvino Gioia , Radaelli Tatjana , Pardi Giorgio
Published: August 2010

Knowledge of fetal nutrient supply has greatly increased in the last decade due to the availability of fetal blood samples obtained under relatively steady‐state conditions. These studies, together with studies utilizing stable isotope methodologies, have clarified some aspects of the supply of the major nutrients for the fetus such as glucose, amino acids and fatty acids. At the same time, the relevance of intrauterine growth has been recognized not only for the well‐being of the neonate and child, but also for later health in adulthood. The major determinants of fetal nutrient availability are maternal nutrition and metabolism together with placental function and metabolism. The regulation of the rate of intrauterine growth is the result of complex interactions between genetic inheritance, endocrine environment and availability of nutrients to the fetus.
The Nobel Prize in 2005 for the discovery of Helicobacter pylori: Implications for child health
Authors: Zetterström Rolf
Published: August 2010

The Nobel Prize in Physiology or Medicine in 2005 has been awarded to B. Marshall and R. Warren for their discovery that peptic ulcer disease is caused by an infection with Helicobacter pylori. This infection, which affects about half of the world's population and is already extremely prevalent in adolescents in developing countries, starts as an asymptomatic gastritis which, under certain conditions, is followed by gastric or duodenal ulcer disease.

Conclusion: No proven benefit has yet been found by treating H. pylori‐infected children with gastritis unless they have a peptic ulcer. Vaccination against H. pylori infection during early childhood is considered a means of preventing peptic ulcer disease and also possibly adenocarcinoma.
Assessment of total body fat using the skinfold technique in full‐term and preterm infants
Authors: Olhager Elisabeth , Forsum Elisabet
Published: August 2010

Background: Assessment of body composition may be of interest when the nutritional status of infants is evaluated but is often difficult since simple and valid methods are lacking. With appropriate validation, measurements based on skinfold thickness (SFT) may be useful for this purpose. Aims: To evaluate the potential of a published method, based on measurements of SFT, to assess total body fat (TBF) of infants; and to calculate the fat content of adipose tissue (AT) in infants using previously published information regarding AT volume and total body water. Subjects and methods: Forty‐five full‐term infants and eight infants born in gestational weeks 31–33 were studied at a postnatal age of 4–131 and 44–75 d, respectively. The body water dilution method was used to obtain reference estimates of TBF (TBF‐BWD). Results: In full‐term infants, TBF assessed using the skinfold method (TBF‐SFT) minus TBF‐BWD was 1.5±10.8% (mean±2 SD). Furthermore, TBF‐SFT minus TBF‐BWD (%, y) was correlated (p<0.0001) with the average of TBF‐SFT and TBF‐BWD (%, x), showing that TBF‐SFT was too high in lean infants and too low in infants with more TBF. In the full‐term infants, AT contained 0.68±0.14 g fat/ml. In the premature infants, TBF‐SFT (%), TBF‐BWD (%) and the AT fat content were similar to the corresponding figures in nine full‐term newborns.

Conclusion: The results indicate that the SFT method produced inaccurate and biased estimates of TBF in infants. A considerable variation between infants regarding their AT fat content may be an important reason for these findings.
Increase of interleukin‐6 in tracheal aspirate at birth: A predictor of subsequent bronchopulmonary dysplasia in preterm infants
Authors: Won Choi Chang , Il Kim Beyong , Kim Han‐Suk , Dong Park June , Choi Jung‐Hwan , Woo Son Dong
Published: August 2010

Aim: We tested whether interleukin‐6 (IL‐6) in tracheal aspirate (TA) at birth, as a marker of fetal pulmonary inflammation, can be a predictor of bronchopulmonary dysplasia (BPD) in preterm infants. Methods: A total of 75 preterm (≤32 wk) infants who were intubated in the delivery room were prospectively enrolled. Multivariate logistic regression analysis was done to determine whether IL‐6 in TA at birth is an independent risk factor for BPD, and a receiver‐operating characteristic curve was constructed to determine the accuracy of IL‐6 in TA for predicting the risk of BPD. Results: IL‐6 in TA at birth was an independent risk factor for BPD. Fetal pulmonary inflammation defined as IL‐6 in TA at birth ≥316 pg/ml together with patent ductus arteriosus (PDA) additively predicted the risk of BPD. The sensitivity, specificity, and positive and negative predictive values of fetal pulmonary inflammation for the identification of BPD were 73%, 71%, 58% and 83%, respectively.

Conclusion: IL‐6 in TA at birth can be used as a predictor of BPD in combination with the presence of PDA.
Umbilical artery catheter blood sampling volume and velocity: Impact on cerebral blood volume and oxygenation in very‐low‐birthweight infants
Authors: Roll Claudia , Hüning Britta , Käunicke Matthias , Krug Jens , Horsch Sandra
Published: August 2010

Aim: Blood sampling from umbilical artery catheters decreases cerebral blood volume and cerebral oxygenation. The aim of this study was to assess the impact of sampling volume and velocity. Methods: Forty‐eight infants, median birthweight 965 g (480–1500 g), median gestational age 27 wk (23–34 wk), were studied during routine blood sampling from umbilical artery catheters. The sampling procedure was performed following a strict protocol for draw‐up volume (1.6 ml), sampling volume (1.7 ml or 0.2 ml), re‐injection volume (1.6 ml) and flushing volume (0.6 ml), time of aspiration (40 s or 80 s), re‐injection (30 s) and flushing (6 s). In each infant, sampling volume and aspiration time were subject to sequential variation in a randomized fashion (1.7 ml/40 s, 1.7 ml/80 s, 0.2 ml/30 s). Using near‐infrared spectroscopy, changes in concentrations of cerebral oxygenated and deoxygenated haemoglobin were measured, and changes in cerebral blood volume and cerebral oxygenation were calculated. Results: During all three sampling procedures, oxygenated haemoglobin decreased significantly from baseline, whereas deoxygenated haemoglobin did not change. Correspondingly, a decrease in cerebral blood volume and cerebral oxygenation occurred. This decrease was not affected significantly by extending the sampling time from 40 s to 80 s, whereas it was blunted by reducing the amount of blood withdrawn.

Conclusion: Blood sampling from umbilical artery catheters induces a decrease in cerebral blood volume and cerebral oxygenation. The magnitude of the decrease depends on the blood volume withdrawn but not on sampling velocity.
The relationship between socio‐economic status, parental support and adolescent physical activity
Authors: Raudsepp Lennart
Published: August 2010

Aim: To examine: 1) the association between socio‐economic status and adolescent physical activity; 2) to assess links between mothers’ and fathers’ social support and adolescents’ physical activity. Methods: Participants were 326 urban adolescents and their parents. Physical activity was measured using a 7‐d physical activity recall. Socio‐economic status and parents’ social support was assessed using questionnaires. Results: Boys were significantly more active than girls, and fathers’ explicit modelling towards boys was higher compared to girls. In contrast, fathers’ and mothers’ logistic support was significantly higher towards their daughters. Social class and fathers’ and mothers’ social support were significantly related to adolescent self‐reported physical activity. Fathers’ explicit modelling was the strongest predictor of adolescent physical activity, predicting 13.5% of the total variance. Social class, fathers’ logistic support and mothers’ explicit modelling were also significant predictors, accounting for additional 14% of the variance in adolescents’ weekly physical activity.

Conclusion: Parental support and social class are positively related to physical activity in Estonian adolescents.
Effects of brief exposure to water, breast‐milk substitutes, or other liquids on the success and duration of breastfeeding: A systematic review
Authors: Szajewska Hania , Horvath Andrea , Koletzko Berthold , Kalisz Marcin
Published: August 2010

Aim: To systematically evaluate the effect of supplemental fluids or feedings during the first days of life on the overall breastfeeding duration and rate of exclusive breastfeeding among healthy infants. Methods: Medical subject headings and free‐language terms were used to search the following electronic databases for studies relevant to breastfeeding: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Library, and La Leche League. Only randomized, controlled trials (RCT) were considered for study inclusion. Results: Of 56 potentially relevant clinical trials identified, only one RCT (170 infants) met the inclusion criteria for this systematic review. In this study, formula feeding was significantly more frequent at 4 wk in the experimental group in which breastfeeding had been supplemented with 5% glucose ad libitum during the first 3 d of life (n=83) than in the exclusively breastfed control group (n=87) (p<0.05). At 16 wk (5 mo postpartum), the percentage of mothers who continued breastfeeding, either exclusively or partially, was significantly lower in the experimental group than in the control group (p<0.01).

Conclusion: There remains considerable uncertainty about the effect of brief exposure to water, breast‐milk substitutes, or other liquids on the success and duration of breastfeeding.
Influence of early postnatal nutritional management on oxidative stress and antioxidant defence in extreme prematurity
Authors: Yeung Melinda Y.
Published: August 2010

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The increased survival of infants born at mid‐gestation in the last decade is associated with significant oxygen free radical‐mediated morbidities. Resuscitation with 100% oxygen, oxidant load from parenteral nutrition fluids, and oxidant stress inherent to the systemic inflammatory state subsequent to infection and tissue injury are all contributory.

Conclusion: Improving early postnatal protein nutrition and the formulation of parenteral nutrition fluids would potentially reduce the oxidative stress and enhance the antioxidant defence of extremely premature newborns.
Nontuberculous mycobacterial adenitis: Effectiveness of chemotherapy following incomplete excision
Authors: Coulter J. Brian S. , Lloyd David A. , Jones Matthew , Cooper John C. , McCormick Maxwell S. , Clarke Raymond W. , Tawil Mohommed I
Published: August 2010

Background: Management of lymphadenopathy caused by nontuberculous mycobacteria (NTM) is primarily surgical. Where this cannot achieve sufficient clearance of infected nodes, chemotherapy is often given. Aim: This study compared results of surgery alone with surgery followed by chemotherapy in instances where there was incomplete surgical removal of diseased tissue. Methods: Chemotherapy comprised azithromycin 10 mg/kg and rifabutin 6 mg/kg both given once daily for 6 mo. Ninety‐eight children with NTM infection were seen in the period 1990–2004. Sixty‐eight cases with adenopathy where “time to healing” (discharge stopped and inflammation settled) was known were available to compare response to treatment. Results: The median (range) “time to healing” in weeks for 43 patients who had surgery alone was: incision and drainage (I&D)/curettage 6 (1–72) (n=10); excision 3 (1–28) (n=22); and from the last operation of multiple (repeat) surgery 3 (1–40) (n=11). For 25 patients who required chemotherapy in addition to surgery, the median (range) “time to healing” in weeks was I&D/curettage 10 (1–40) (n=17), excision 14 (8–20) (n=2) and multiple surgery 29 (2–88) (n=6).

Conclusion: In children with adenitis due to NTM, where surgical resection is followed by continued discharge and inflammation, chemotherapy should be considered before further surgery is undertaken.
Oral aphthous ulcers and dental enamel defects in children with coeliac disease
Authors: Bucci Paolo , Carile Francesco , Sangianantoni Anna , D'Angiò Franca , Santarelli Andrea , Lo Muzio Lorenzo
Published: August 2010

Aim: Coeliac disease is characterized by oral manifestations, such as dental enamel defects and recurrent oral aphthae. In this study we compared the prevalence of enamel defects and recurrent aphthous stomatitis (RAS) between patients diagnosed with coeliac disease and healthy controls. Methods: A total of 72 patients with coeliac disease were studied together with 162 normal healthy subjects as controls to individualize the prevalence of enamel defects and recurrent aphthous stomatitis (RAS) in this disease. Results: Dental enamel defects were found in 14/70 (20%) coeliac patients and in 9/159 (5.6%) controls. In particular, 13/53 (24.5%) coeliac patients with mixed or permanent dentition and 1/17 (5.8%) coeliac children with deciduous dentition had enamel defects. Altogether, 9/145 (6.2%) control subjects with mixed or permanent dentition had dental enamel defects. None of the controls with deciduous dentition had enamel defects. Thus, the enamel defects occurred more frequently in coeliac patients (p<0.001). Regarding RAS, 24/72 (33.3%) coeliac patients and 38/162 (23.4%) control subjects had aphthous ulcers. Statistically significant differences were not observed between the two groups (p > 0.05). One in three coeliac subjects suffering from RAS received benefit from a gluten‐free diet.

Conclusion: In the present study, the prevalence of enamel defects was found to be greater in coeliac patients than healthy controls. Even though the prevalence of RAS in coeliac subjects varied from healthy controls, the difference was not statistically significant. However, more than 1/3 coeliac subjects suffering from RAS benefited from a gluten‐free diet.
Children with chronic conditions in a paediatric emergency department
Authors: Massin Martial M. , Montesanti Jessica , Gérard Paul , Lepage Philippe
Published: August 2010

Aim: To describe the use of a paediatric emergency department by children with chronic conditions. Material and methods: We prospectively indexed all the children seen in our emergency department during 1 y to describe the population of children with chronic conditions, and to compare it with the general paediatric population. Results: There were 11 483 patient visits, of which 11% were by chronically ill children. Six subspeciality areas accounted for the vast majority of the chronic conditions seen: neurology (30%), cardiology (18%), pulmonology (18%), nephro‐urology (16%), haemato‐oncology (9%) and endocrinology (4%). Admission rate to the hospital was significantly higher for chronically ill patients (38% vs 23%). Among chief complaints, fever, respiratory distress, headache and seizures were overrepresented in chronically ill children. The chief complaint was related to the child's chronic condition in 51% of the visits. In both chronically and non‐chronically ill patients, the majority of final diagnoses were related to infection (57% and 65%, respectively). Among diagnoses, bacterial infections, seizures, vasovagal syncopes and asthma were overrepresented in chronically ill children.

Conclusion: From the analysis of our data, we conclude that children with chronic conditions account for a tenth of all visits to a paediatric emergency department. The paediatric emergency physicians provide an important service to both the children with chronic conditions and the subspecialists who care for them.
Elevation of serum creatine kinase in response to medical treatment of Graves’ disease in children
Authors: Mizuno Haruo , Sugiyama Yukari , Nishi Yoshikazu , Ueda Noriko , Ohro Yoichiro , Togari Hajime
Published: August 2010

We describe two cases of increases in serum creatine kinase (CK) concentrations in children undergoing treatment of Graves’ disease with antithyroid medications. Presenting complaints consisted of myalgias and muscle cramping in both patients, and increases in serum CK levels were noted 1 mo after initiation of antithyroid drugs. Both patients were euthyroid at the time of CK elevation. While the mechanisms for this process are not clear, it is likely that the acute decrease of thyroid hormones in tissues following a state of chronic hyperthyroidism may result in relative hypothyroid states and subsequent alterations in CK concentrations.

Conclusion: Although this side effect has been reported in adults, it is a novel finding in children. Clinicians should be aware of the rare potential for elevations in serum CK when initiating treatment for Graves’ disease in children.
Intracranial germinoma: A rare but important differential diagnosis in children with growth retardation
Authors: Gottschling Sven , Graf Norbert , Meyer Sascha , Reinhard Harald , Krenn Thomas , Rohrer Tilman
Published: August 2010

Aim: Intracranial germinoma is a rare malignant tumour in childhood with an excellent prognosis under adequate therapy. Finding the right diagnosis at an early stage is difficult because of the slow‐growing tumour and the resulting lack of clinical symptoms. Methods: Our patients with histologically secured germinoma were retrospectively assessed concerning growth retardation, pituitary hormone status, magnetic resonance imaging scan results and clinical symptoms to find out whether there is a leading parameter. Results: In all our patients, the leading symptom was growth retardation of at least 2 y before being diagnosed.

Conclusion: Growth retardation seems to be a very early sign of germinoma in the suprasellar region. Therefore, early neuroradiological imaging combined with pituitary hormone status should be considered in every paediatric patient with a history of secondary growth retardation.
Testicular growth from birth to two years of age, and the effect of orchidopexy at age nine months: A randomized, controlled study
Authors: Kollin Claude , Hesser Ulf , Martin Ritzén E , Karpe Bengt
Published: August 2010

Aim: To study whether surgical treatment at age 9 mo in boys with congenital unilaterally palpable undescended testes (cryptorchidism) is followed by improved growth of the previously retained testes compared to non‐treatment. Methods: At the age of 6 mo, 70 boys were randomized to surgical treatment at 9 mo and 79 boys to treatment at 3 y of age. The boys were then followed at 12 and 24 mo. Ultrasonography was used to determine testicular volume. Results: After orchidopexy, the previously retained testes resumed growth and were significantly larger than the non‐operated testes at 2 y (0.49 ml vs 0.36 ml, p<0.001). Testicular growth after orchidopexy was also demonstrated by a higher mean ratio between the previously retained and the scrotal testes of the individual boys at 2 y: 0.84 for the surgically treated group, compared to 0.63 for the untreated group (p<0.001).

Conclusion: Surgery at 9 mo has a beneficial effect on the growth of previously undescended testes.
Breastfeeding duration and blood pressure among Brazilian adolescents
Authors: Horta Bernardo L. , Victora Cesar G. , Lima Rosangela C. , Gonçalves Helen , Guimarães Beatriz E. , Barros Fernando C.
Published: August 2010

Objective: To assess the relationship between breastfeeding duration and blood pressure in a large birth cohort of Brazilians followed from birth to adolescence. Methods: All 5914 hospital births occurring in Pelotas in 1982 (over 99% of all deliveries) were studied prospectively. Detailed information on feeding practices was prospectively collected during childhood. In 1997 and 2001 we attempted to trace a sample of the cohort, whereas in 2000 we identified the male subjects when presenting for the army recruitment exam. Blood pressure measurements were taken in 1997 for both sexes, males in 2000 and females in 2001. Results: Information on breastfeeding collected between 1983 and 1986 was available for 90.8% of the 5914 original cohort subjects. We managed to follow 1076, 2250 and 1031 subjects in 1997, 2000 and 2001, respectively. Total breastfeeding duration was not associated with systolic and diastolic blood pressure in adolescence. Diastolic blood pressure at the age of 15 y (1997) was higher among girls who had been predominantly breastfed for at least 4 mo. After controlling for confounding variables (family income, maternal education at birth and maternal BMI at birth, skin colour, birthweight, gestational age, maternal smoking during pregnancy, adolescent smoking and alcohol drinking), the strength of the association was reduced and the 95% confidence interval encompassed the other blood pressure estimates. Furthermore, such association was not replicated in the 2001 follow‐up visit.

Conclusion: Breastfeeding duration was not related to blood pressure in adolescence.