bluuebunny/crossref_metadata_2025 huggingface dataset:
Neighbourhood social and socio‐economic composition andinjury risks
Authors: Reimers Anne , Laflamme Lucie
Published: August 2010

Aim:To investigate whether social and socio‐economic characteristics of the population within a parish influence childhood injury.Methods:The study encompasses all children aged 0–15 y living in Stockholm County over the 3‐y period 1999–2001 (about 360 000 children per year), grouped into parish of residence (138 parishes). The effect of parish attributes on injury rate were analysed based on three indices (deprivation, socio‐economic status and social integration) derived by a factor analysis of 11 characteristics of the parishes' population, each index being split into three levels. Childhood injury resulting in at least one night of hospitalization during the period 1999–2001 was considered (n=5540) by index, and rate ratios were calculated for 12 injury causes using parishes forming the best level of the index as the reference group.Results:Higher levels of deprivation negatively influenced pedestrian injury rates, had a protective effect on other traffic‐related injuries, and negatively affected some other types of unintentional injuries. Higher concentrations of people with low socio‐economic status did not impact on the risk of traffic and fall injuries, but increased that of burns/scalds and cases of poisoning. Parishes with lower levels of social integration had significantly higher rates of bicycle‐ and moped‐related injuries, and also of self‐inflicted ones.

Conclusion:Compositional characteristics of the population in a residential area affect injury to varying degrees and direction according to type of injury. The underlying mechanisms are likely to be specific to injury type.
Doppler ultrasonographic detection of nutcracker syndrome in a young child with intussusception: A case report
Authors: Il Shin Jae , Min Lee Soon , Min Park Jee , Ho Shin Youn , Seung Lee Jae , Joon Kim Myung
Published: August 2010

We report on a 2‐y‐old male with intussusception accompanying nutcracker syndrome detected by renal Doppler ultrasound. Renal Doppler ultrasound revealed a significant difference in the peak velocity between the hilar and aortomesenteric portions of the left renal vein.

Conclusion: Renal Doppler ultrasound has been very useful and effective in detecting nutcracker syndrome in a young child.
On the clinical relevance of early deficits in critical linguistic functions
Authors: Lacerda Francisco
Published: August 2010

The clinical significance of patterns of deficits in semantic and phonological representations observed by Miniscalco et al. is discussed in light of an ecological approach to language development.

Conclusion: Deficits in semantic representations reflect problems in capturing the core linguistic referential function and should be taken as serious early warning signals for language delay.
Introduction of complementary food to infants within the first six months postpartum in rural Vietnam
Authors: Duong Dat V , Binns Colin W , Lee Andy H
Published: August 2010

Aim: To document the introduction of complementary food and factors influencing the decision to feed infants with solid food within 6 mo postpartum in rural Vietnam. Methods: A longitudinal study of 463 women who gave birth during August–October 2002 was conducted. Results: An early introduction of complementary food was found, which increased from 16.4% at week 1 to 56.5% at week 16 and nearly 100% at week 24. Home‐cooked solid food was introduced by 4.8%, 40.9% and 74.3% of women at weeks 1, 16 and 24, respectively. Logistic regression analysis found that at week 24 postpartum, it was less likely for the infant to be fed with solid food if the mother was a farmer (OR 0.52, 95% CI: 0.18–0.95) and passed secondary school (OR 0.28, 95% CI: 0.10–0.54), whose husband was satisfied with the infant's sex (OR 0.30, 95% CI: 0.17–0.53), her mother‐in‐law preferred exclusive breastfeeding (OR 0.18, 95% CI: 0.04–0.75), or her friends practised exclusive breastfeeding (OR 0.41, 95% CI: 0.16–1.10). However, infants were likely to be fed with solid food when their parents had higher income and lived independently (OR 1.76, 95% CI: 1.01–3.06).

Conclusion: Community mobilization for sharing the workload with women could help them to cope with employment and breastfeeding.
Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: A cohort study in 13 European centres
Authors: Gras Luuk , Wallon Martine , Pollak Arnold , Cortina‐borja Mario , Evengard Birgitta , Hayde Michael , Petersen Eskild , Gilbert Ruth
Published: August 2010

Aim: To determine the effectiveness of prenatal treatment for clinical manifestations of congenital toxoplasmosis. Methods: We prospectively identified 255 live‐born infants with congenital toxoplasmosis using prenatal or neonatal screening. We determined the effect of prenatal treatment on the risks of intracranial or ocular lesions in infancy, accounting for gestational age at maternal seroconversion. Results: Prenatal treatment within 4 wk of seroconversion reduced the risk of intracranial lesions compared with no treatment (odds ratio, OR 0.28; 95% CI: 0.08–0.75), but there was no significant effect when initiated after 4 wk (OR 0.76; 95% CI: 0.35–1.59; overall p‐value 0.19). Compared to spiramycin alone, no treatment doubled the risk of intracranial lesions (OR 2.33; 95% CI: 1.04–5.50), but the risk did not differ with pyrimethamine‐sulphonamide treatment (overall p‐value 0.52). There was no consistent relationship between the type or timing of treatment and the risk of ocular lesions. Gestational age at maternal seroconversion was inversely associated with the risk of intracranial but not ocular lesions.

Conclusion: Only early versus no prenatal treatment for intracranial lesions showed a statistically significant benefit. A large randomized controlled trial and/or meta‐analysis of individual patient data from cohort studies is required to confirm these findings.
Low incidence of adverse events following 90‐minute and 3‐minute infusions of intravenous iron sucrose in children on erythropoietin
Authors: Theodore Anbu Anbarasu , Kemp Timothy , O'donnell Kate , Smith Patricia A , Bradbury Mark G
Published: August 2010

Aim: To define the adverse events following two different rates and methods of intravenous iron sucrose infusions in children with anaemia due to chronic renal impairment. Methods: Two prospective observational studies were undertaken to characterize the adverse events following iron sucrose administration in children with renal impairment and on erythropoietin. Between January 1999 and April 2003, 5 mg/kg of intravenous (IV) iron sucrose was given over 90 min and repeated 24 h later. Between May 2003 and September 2004, in children with better venous access, a single dose of 2 mg/kg of IV iron sucrose was administered over 3 min during an outpatient clinic visit and haemodialysis sessions. Following infusions, children were monitored for immediate and delayed adverse events. All such events were documented and dealt with appropriately. Test doses were not used. Results: A total of 870 infusions over 90 min were administered to 72 children. Three children developed abdominal pain. One child developed worsening of hypertension (not related to iron sucrose). Sixty‐five doses were administered over 3 min to 20 children, and six minor adverse events were documented.

Conclusion: Although 90 min infusion is associated with fewer adverse events, no life‐threatening events were documented in either method.
Effects of tidal volume and positive end‐expiratory pressure during resuscitation of very premature lambs
Authors: Probyn Megan E , Hooper Stuart B , Dargaville Peter A , Mccallion Naomi , Harding Richard , Morley Colin J
Published: August 2010

Background: Guidelines recommend neonatal resuscitation without controlling tidal volume or positive end‐expiratory pressure (PEEP). However, these may improve gas exchange, lung volume and outcome. Aim: To investigate resuscitation of very premature lambs with a Laerdal bag without PEEP versus volume guarantee ventilation with PEEP. Methods: Anaesthetized lambs (n=20) delivered at 125 d gestation were randomized to three groups receiving 15 min resuscitation: (1) Laerdal bag and no PEEP; (2) ventilation with a tidal volume of 5 ml/kg and 8 cm H2O PEEP; (3) ventilation with 10 ml/kg and 8 cm H2O PEEP. They were then all ventilated for 2 h with tidal volumes of 5 or 10 ml/kg, and 8 cm H2O PEEP. Ventilation parameters and blood gases were recorded. Results: Different tidal volumes affected PaCO2 within minutes, with 10 ml/kg causing severe hypocarbia. PEEP had little effect on PaCO2. Oxygenation improved significantly with PEEP of 8 cm H2O, irrespective of tidal volume.

Conclusion: Very premature lambs can be resuscitated effectively using volume‐guarantee ventilation and PEEP. Tidal volumes affected PaCO2 within minutes but had little effect on oxygenation. PEEP halved the oxygen requirement compared with no PEEP. Resuscitating premature babies with controlled tidal volumes and PEEP might improve their outcome.
Being old‐for‐grade and drug use: Not such a clear connection
Authors: Surís Joan‐carles , Parera Núria
Published: August 2010

Aim: To assess whether repeating a grade was associated with drug use among adolescents after controlling for personal, family and school‐related variables, and whether there were differences between students in mandatory and post‐mandatory school. Methods: Data were drawn from the Catalonia Adolescent Health Survey, a cross‐sectional study of in‐school adolescents aged 14–19 y. The index group included 366 subjects who were repeating a grade at the time the survey was carried out (old‐for‐grade, OFG). A control group matched by gender, school and being one grade ahead was randomly chosen among all the subjects who had never repeated a grade. All statistically significant variables in the bivariate analysis were included in a multivariate analysis. In a second step, all analyses were repeated for students in mandatory (14–16 y) and post‐mandatory (17–19 y) school. Results: After controlling for background variables, subjects in the index group were more likely to perceive that most of their peers were using synthetic drugs and to have ever used them, to have bad grades and a worse relationship with their teachers. OFG students in mandatory school were more likely to have divorced parents, bad grades and have ever used synthetic drugs, whereas they were less likely to be regular drinkers. OFG students in post‐mandatory school were more likely to have below average grades, to be regular smokers and to perceive that most of their peers used synthetic drugs.

Conclusions: When background variables are taken into consideration, the relationship between repeating a grade and drug use is not so clear. By increasing the familial and academic support of adolescents with academic underachievement, we could reduce their drug consumption.
Vitamin K status of preterm infants with a prolonged prothrombin time
Authors: Clarke Paul , Mitchell Simon J , Sundaram Shanmuga , Sharma Vibha , Wynn Robert , Shearer Martin J
Published: August 2010

Aim: To investigate the vitamin K status of preterm infants who have a prolonged prothrombin time (PT) in the first month of life. Methods: Measures of vitamin K status were assessed in 21 preterm infants who were found to have an abnormal PT, despite 0.2–0.5 mg vitamin K1 prophylaxis at birth. Results: All infants had normal or supraphysiological vitamin K1 concentrations and undetectable or, in one infant, insignificant PIVKA‐II, indicating adequate vitamin K status.

Conclusion: In preterm infants born at <32 wk gestation who received 0.2 mg vitamin K1 after delivery, a prolonged PT in the first month of life is unlikely to be due to vitamin K deficiency.
Interleukin‐13 is involved in the survival of children with sepsis
Authors: Blanco‐quirós Alfredo , Casado‐flores Juan , Garrote Adrados Jose A , Nieto Moro Monserrat , Asensio Antón Julia , Arranz Sanz Eduardo
Published: August 2010

Forty‐eight children with sepsis were studied. Interleukin‐13 (IL‐13) levels were lower in patients who died at admission (p=0.014) and at 6 h (p=0.037), and in patients with refractory shock at 0 (p=0.03) and particularly at 6 h (p=0.0009). IL‐13 levels did not correlate with other cytokines (IL‐1b, IL‐10, IL‐12, TNFr), CRP or neutrophil count. Low IL‐13 levels in the early hours of sepsis are associated with poor prognosis.

Conclusion: IL‐13, a Th‐2 cytokine fundamental in the pathogenesis of atopy, might also have a protective role against severe infections in children.
Congenital systemic Langerhans cell histiocytosis presenting as hydrops fetalis
Authors: Lee Cheuk H , Lau Tze K , To Ka F , Lam Hugh S , Chan Anthony WH , Ng Pak C
Published: August 2010

Congenital Langerhans cell histiocytosis (LCH) encompasses a wide spectrum of disease involvement and severity. Congenital “self‐healing” cutaneous LCH represents one end of the spectrum, whereas the case we encountered represents the other extreme. A rare case of congenital LCH with severe multiorgan involvement presenting as hydrops fetalis is described in this report. Hydrops fetalis has not previously been associated with congenital LCH. The overall clinical features of this infant closely mimicked those of disseminated congenital infection, and he ran a fulminant and rapidly fatal course.

Conclusion: A high index of suspicion is required to diagnose congenital LCH in the early neonatal period. Hydrops fetalis is an ominous sign and probably reflects severe systemic disease compromising the well‐being of the fetus.
A case of macroprolactinoma and elevated insulin‐like growth factor‐I in a young boy
Authors: Eyal Ori , Naffaa Lena N , Elder Deborah A
Published: August 2010

We report a case of a 10‐y‐old boy who presented with persistent headache and was found to have a giant prolactinoma. Laboratory evaluation revealed markedly elevated prolactin (PRL) level, thyroid‐stimulating hormone (TSH) deficiency, and elevated insulin‐like growth factor‐I (IGF‐I). He had normal random growth hormone (GH) but non‐suppressible GH during oral glucose tolerance test (OGTT). Cabergoline treatment was initiated and was well tolerated. Therapy successfully reduced PRL levels, normalized IGF‐I levels, and reduced tumor size.

Conclusion: Our patient presented with a GH‐PRL‐secreting tumor. Dopamine agonists are recommended as the treatment of choice for prolactinomas. However, there should be careful attention to GH status when treating GH‐PRL‐secreting tumor with dopamine agonists alone. IGF‐I levels should be followed in all patients with prolactinoma, even in those with normal basal GH concentrations, because of the possibility of GH co‐secretion.
Faecal calprotectin in children with chronic gastrointestinal symptoms
Authors: Bremner Alan , Roked Sohere , Robinson Rebecca , Phillips Ian , Beattie Mark
Published: August 2010

Aims: Faecal calprotectin, a neutrophil cytosolic protein, is raised in inflammatory bowel disease. We assessed this investigation in evaluating children with chronic intestinal symptoms. Methods: Stool samples from 100 children aged 5–17 years (referrals to the regional paediatric gastroenterology service) were tested using a commercially available kit. Results: Calprotectin was higher in inflammatory bowel disease than normal children (p<0.0001) or in those with functional constipation (p<0.0001). The overall specificity for organic bowel disorders was 85%. Calprotectin correlated with C‐reactive protein in inflammatory bowel disease (p=0.001), and clinical disease activity in ulcerative colitis (p=0.017), but not with disease activity in Crohn's disease.

Conclusion: Raised faecal calprotectin should prompt further assessment in children with chronic intestinal symptoms, since an organic bowel disorder is likely. However, calprotectin cannot be regarded as a specific test for idiopathic inflammatory bowel disease.
Polyarteritis nodosa presenting with a leg mass
Authors: Faller Gail , Kala Udai K , Hale Martin J
Published: August 2010

We report an unusual presentation of polyarteritis nodosa in a 2‐y‐old child. The child presented with a mass of the left leg adjacent to the calf, and the biopsy showed polyarteritis nodosa. Further investigations confirmed systemic features, and X‐rays showed a periosteal reaction.

Conclusion: Childhood polyarteritis nodosa may present with a lower limb inflammatory mass.
Raynaud phenomena and migraine in two children: Inclusion within a family of related disorders
Authors: Besser Rachel EJ , Stern Colin MM
Published: August 2010

We report a case of two siblings with Raynaud phenomena and migraine, whose symptoms were successfully treated with pizotifen.

Conclusion: To our knowledge, this is the first case documenting the association between Raynaud phenomena and migraine in two siblings with a family history of Raynaud phenomena and ischaemic heart disease.
Effects of early intake of fruit or vegetables in relation to later asthma and allergic sensitization in school‐age children
Authors: Njå Frode , Nystad Wenche , Lødrup Carlsen Karin C , Hetlevik Øystein , Carlsen Kai‐Håkon
Published: August 2010

Aim: To assess the associations between nutrition supplements in infancy and later asthma and allergy in school‐age children, and to explore the impact of environmental factors in early life. Methods: Five hundred and two children underwent clinical examination, skin prick test and a second parentally completed questionnaire within 2 y of a cross‐sectional questionnaire‐based study, including 4585 primary school children (6–16 y old) in 1994 from urban Oslo (37%), the mountainous area of Hallingdal (42%), and the industrial, coastal area of Odda (21%). The children were selected from the 1994 survey on the basis of reported diagnosed asthma (n=166), wheeze in the last 12 mo (n=155) and no asthma/no wheeze (n=181). Questions were related to nutrition and environmental exposure in early life. Possible associations between allergic sensitization or asthma at school age and exposures were estimated by logistic regression analysis, adjusting for potential confounders. Results: Daily intake of fresh fruit or vegetables, but not extra vitamins or cod liver oil supplements, in infancy decreased the risk of asthma (adjusted odds ratio (aOR) 0.57 (95% confidence interval (CI): 0.37–0.88). Early supplements of cod liver oil and extra vitamins were associated with increased allergic sensitization (aOR 1.78 (95% CI: 1.03–3.07) and 1.71 (95% CI: 1.01–2.88), respectively). A significantly higher prevalence of allergic sensitization was found in children living in Hallingdal compared to Odda, while the latter children, on the other hand, had the highest prevalence of house dust mite allergy ( p=0.001 vs Hallingdal and p=0.04 vs Oslo).

Conclusion: The present study suggests that the early introduction of daily fresh fruit or vegetables may decrease the risk of asthma after 1 y of life, whereas allergic sensitization at school age seemed to increase with extra vitamin and cod liver oil supplements during infancy. Living area influenced allergic sensitization, with differences between coastal and inland areas.
Homeostatic role of IL‐7 in HIV‐1 infected children on HAART: Association with immunological and virological parameters
Authors: Resino S , Galán I , Correa R , Pajuelo Lucia , Bellón J MÁ , Muñoz‐Fernández Ma Á
Published: August 2010

Aim: To investigate the role of IL‐7 in HIV‐infected children on highly active antiretroviral therapy (HAART) and its association with laboratory parameters related to disease progression. Patients and methods: A cross‐sectional study in 31 vertically HIV‐infected children (median age 8.4 y) treated with HAART, and a longitudinal study in four of those same children was carried out. In both studies, viral load, CD4+ T‐cell counts, thymic production of T cells by TCR rearrangement excision circles (TRECs), IL‐7 plasma levels and viral phenotype were determined. Results: IL‐7 levels were higher in HIV‐infected children than in age‐matched, uninfected controls. In addition, HIV children with CD4+ T cells between 200 and 500 T cells/mm3 had higher IL‐7 levels and lower TREC values than HIV‐infected children with CD4+ T cells >500 T cells/mm3. IL‐7 levels were higher in children with syncytium‐inducing (SI) phenotype than in those with non‐syncytium‐inducing (NSI) variants. During the follow‐up of four HIV children, the decrease in viral load after HAART was always associated with a recovery of CD4+ T cells and TRECs, which was followed by a decrease in IL‐7 returning to the levels present prior to the drop in CD4+ T cells. The four HIV‐infected children had SI/X4 isolates in PBMC before HAART, and the viral phenotype switched to NSI/R5 after HAART.

Conclusion: Our data suggest that IL‐7 plays a key role in the maintenance of T‐cell homeostasis in HIV‐infected children on HAART, both through peripheral expansion and through a thymus‐dependent mechanism.
Deep venous thrombosis in a child associated with an abnormal inferior vena cava
Authors: Sakellaris G , Tilemis S , Papakonstantinou O , Bitsori M , Tsetis D , Charissis G
Published: August 2010

Congenital anomalies of the inferior vena cava (IVC), such as absence or atresia, although well documented, are uncommon and result from aberrant development during embryogenesis. Absence or atresia of the IVC is usually discovered accidentally. Patients are typically asymptomatic of the condition itself. Many concurrent cardiovascular‐associated abnormalities have been described. We report a 10‐y‐old boy admitted to the emergency room with painful swelling of his right lower limb without previous trauma or surgery. After 3 d, swelling also involved the left lower limb. A Doppler ultrasound of the lower limbs revealed bilateral thrombosis of the vena iliaca communis, vena iliaca externa, femoral vein communis and superficial extending to the IVC. Magnetic resonance imaging (MRI) of the abdomen was performed. On MRI, we demonstrated a hypoplastic IVC. The results of blood coagulation studies, including levels of antiphospholipid antibodies, proteins C and S, and antithrombin III, were normal. The patient was treated with intravenous heparin for 8 d and discharged with oral warfarin therapy, which has been recommended for life.

Conclusion: Therapy against deep venous thrombosis must be focused on its prevention in the future. An abnormal inferior vena cava should be considered in young patients with deep venous thrombosis without apparent cause.
Bacterial aetiology of acute osteoarticular infections in children
Authors: Moumile K , Merckx J , Glorion C , Pouliquen JC , Berche P , Ferroni Agnes
Published: August 2010

Aim: To study the bacterial aetiology of acute osteoarticular infections in children and to analyse the efficiency of culture methods. Methods: Bacteriological data of 407 cases of clinically suspected osteoarticular infections affecting 406 children hospitalized in an orthopaedic surgery department between 1999 and 2002 were retrospectively reviewed. Results: Bacterial cultures from clinical specimens were positive in 74 cases (18%): 38 cases of septic arthritis and 36 cases of bone infections (osteitis, osteomyelitis or osteoarthritis). The use of liquid medium bottles to grow bacteria from articular fluids increased the rate of positive cultures compared to the use of standard solid media (p=0.0001). The most commonly recovered pathogen was Staphylococcus aureus (44%) followed by Kingella kingae (14%), Streptococcus pyogenes (10%) and Streptococcus pneumoniae (10%). K. kingae was most frequently isolated among children under 36 mo of age (p=0.0003), whereas S. aureus was most frequently isolated among children over 36 mo (p=0.0015).

Conclusion: By improving our culture method, we observed a recrudescence of isolation of K. kingae, but S. aureus remains the main pathogen isolated from osteoarticular infections in children. This finding is useful for the adaptation of a probabilistic antibiotic treatment of these infections.
The Milan Project: A newborn hearing screening programme
Authors: Pastorino Giancarlo , Sergi Paola , Mastrangelo Massimo , Ravazzani Paolo , Tognola Gabriella , Parazzini Marta , Mosca Fabio , Pugni Lorenza , Grandori Ferdinando
Published: August 2010

Aim: Since 1997 a newborn hearing screening programme has been implemented by the U.O. Neurologia‐Neurofisiopatologia and Dipartimento di Neonatologia of the Istituti Clinici di Perfezionamento ICP in Milan for both babies with no risk and those at risk of hearing impairment. This programme was named the Milan Project. Methods: The protocol for no‐risk babies consisted of three stages: in the first two stages, newborns were tested with transient click‐evoked otoacoustic emissions (TEOAE), in the third one with conventional auditory brainstem responses (ABR). The first TEOAE test was performed by 36 h of age, before discharge, the second one after 15–30 d in case of referral, and the third one, by ABR, for those babies who failed the second TEOAE stage. Newborns at audiological risk were submitted to conventional ABR before the third month of corrected age. Some of this latter population was also submitted to the TEOAE test. The entire tested population (no‐risk babies and newborns at audiological risk) consisted of 19 777 babies: 19 290 without risk (“no risk”) and 487 at risk (“at risk”). Results: During the course of the Milan Project, hearing impairment (ABR threshold equal to or greater than 40 dB nHL) was identified in 63 newborns (19 from the no‐risk and 44 from the at‐risk population), with a prevalence of 0.32%. Bilateral hearing impairment (BHI) was found in 33 newborns (10 from the no‐risk and 23 from the at‐risk population), corresponding to 0.17%. Among infants with bilateral hearing impairment, 30.3% had no risk factors. The prevalence of hearing impairment was determined on days 15–30 after birth.

Conclusions: The results show that the implementation of a hospital‐based, universal neonatal hearing screening programme for babies with and without audiological risk is feasible and effective. The effectiveness of the programme has increased as a function of the years since its inception, with a strong decrease in the referral rate. Further improvement is obtained if the TEOAE measurements are repeated in cases of referral scoring before discharge.
Anti‐Cw alloimmunization presenting as hydrops fetalis
Authors: Gopalam Kollamparambil Tanoj , Rameshchandra Jani Bhavdeep , Aldouri Maadh , Soe Aung , Ducker David Anthony
Published: August 2010

Cw is a low frequency red cell antigen that belongs to the Rh blood groups system. While not uncommon, anti‐Cw is rarely associated with clinically significant haemolytic disease of the newborn (HDN). When it does occur, it is offen subclinical or of mild to moderate clinical severity. In the majority of pregnancies it is considered to be a naturally occurring antibody and has not been reported to cause hydrops fetalis or stillbirth. We report a case of anti‐Cw alloimmunization, which was associated with significant anaemia and hydrops fetalis, presenting at 35 wk gestation.
Kangaroo Mother Care: 25 years after
Authors: Charpak Nathalie , Gabriel Ruiz Juan , Zupan Jelka , Cattaneo Adriano , Figueroa Zita , Tessier Rejean , Cristo Martha , Anderson Gene , Ludington Susan , Mendoza Socorro , Mokhachane Mantoa , Worku Bogale
Published: August 2010

The components of the Kangaroo Mother Care (KMC) intervention, their rational bases, and their current uses in low‐, middle‐, and high‐income countries are described. KMC was started in 1978 in Bogotá (Colombia) in response to overcrowding and insufficient resources in neonatal intensive care units associated with high morbidity and mortality among low‐birthweight infants. The intervention consists of continuous skin‐to‐skin contact between the mother and the infant, exclusive breastfeeding, and early home discharge in the kangaroo position. In studies of the physiological effects of KMC, the results for most variables were within clinically acceptable ranges or the same as those for premature infants under other forms of care. Body temperature and weight gain are significantly increased, and a meta‐analysis showed that the kangaroo position increases the uptake and duration of breastfeeding. Investigations of the behavioral effects of KMC show rapid quiescence. The psychosocial effects of KMC include reduced stress, enhancement of mother–infant bonding, and positive effects on the family environment and the infant's cognitive development.

Conclusion:Past and current research has clarified some of the rational bases of KMC and has provided evidence for its effectiveness and safety, although more research is needed to clearly define the effectiveness of the various components of the intervention in different settings and for different therapeutic goals.
Ethical aspects of neonatal screening for sickle cell disease in Western European countries
Authors: De Montalembert Mariane , Bonnet Doris , Lena‐Russo Danielle , Louise Briard Marie
Published: August 2010

Sickle cell disease raises some important ethical questions regarding neonatal screening in Western European countries such as France, England or Belgium, which have already introduced either universal or selective screening. Such screening is aimed at benefiting children affected with major sickle cell syndrome. It also detects heterozygous babies and, in doing so, heterozygous parents. The latter information, which is ignored most of the time, risks making parents feel guilty and can raise fears of stigmatization. Whether it would change their future reproductive decisions requires further studies, for cultural and religious reasons may have a strong negative influence on the request for prenatal diagnosis. Disclosure of the child's illness may oblige the family to remain in the country they have emigrated to because it offers the best chance of treatment. As a result, links between the family and its original community are modified. Parents must more or less sever links with their family in Africa and try to trust and adapt to the public health services in Europe.

Conclusion: Neonatal screening of sickle cell disease is highly ethical in facilitating the prevention of the early death of affected children. It also detects heterozygous parents and offers at‐risk couples the possibility to perform a prenatal diagnosis during the next pregnancy. Adequate counselling must consider the risk of stigmatization that carrier status represents, especially for women in many cultural beliefs, and the numerous cultural and religious reasons which limit parental uptake for prenatal diagnosis. Disclosure of their child's illness may oblige immigrant families to stay in Europe, where free and adapted healthcare is available.
Type 2 diabetes mellitus in European children and adolescents
Authors: Malecka‐Tendera Ewa , Erhardt Éva , Molnár Dénes
Published: August 2010

Aim: The aim of the study was to review the published and unpublished data on type 2 diabetes in European children in order to determine how common this problem is in the dominantly Caucasian population. Methods: The MEDLINE database was searched and a questionnaire was distributed among European Childhood Obesity Group (ECOG) representatives from 16 countries. Results: One hundred and eighty‐four children with type 2 diabetes were diagnosed in Europe, 144 of them of Caucasian origin. The majority of them were overweight females and, had positive family history for type 2 diabetes mellitus.

Conclusion: Because of the significant rates of type 2 diabetes in Europe, screening for it in obese children and adolescents is highly recommended.
Ultraviolet B radiation improves serum levels of vitamin D in patients with cystic fibrosis
Authors: Gronowitz Eva , Larkö Olle , Gilljam Marita , Hollsing Annika , Lindblad Anders , Mellström Dan , Strandvik Birgitta
Published: August 2010

Background: Ultraviolet B (UVB) radiation can be used in the prevention and treatment of vitamin D deficiency. Aim: To investigate, in a controlled study of patients with cystic fibrosis (CF), whether regular UVB radiation would improve serum levels of calcidiol during the dark season (October–April). Methods: Thirty patients with mild to moderate disease were included (aged 9–40 y). All patients had cholecalciferol supplementation. One group (15 patients) was given UVB one to three times a week for 6 mo and one group (15 sex‐ and age‐matched patients) served as controls. The radiation source consisted of three TL 12/40W UVB fluorescent lamps. Initial treatment duration was 1 min, subsequently increased by 0.5–1 min/treatment to a maximum of 10 min. Results: The mean initial serum calcidiol levels were 21 ng/ml in the controls and 22 ng/ml in the intervention group. Serum calcidiol levels increased to 44 ng/ml after 8 wk and to 50 ng/ml after 24 wk of UVB radiation; the corresponding serum levels in the controls were 19 and 25 ng/ml, respectively. The mean serum calcitriol levels increased in the treated group and were unaltered in the control group.

Conclusions: UVB radiation was effective in increasing vitamin D levels in patients with CF. The study results imply that UVB radiation is valuable in chronic conditions associated with vitamin D deficiency.
Sudden unexplained death in children with epilepsy: A cohort study with an eighteen‐year follow‐up
Authors: Weber Peter , Bubl Reinhard , Blauenstein Ursula , Tillmann Bettina U , Lütschg Jürg
Published: August 2010

Aim: Sudden unexplained death is a significant cause of mortality in adults with epilepsy. Only a few data exist about this risk in childhood. Methods: Cases of sudden unexplained death in epilepsy (SUDEP) up to the age of 18 y occurring at our hospital between 1984 and 2001 were identified. The incidence rate was calculated on the basis of diagnosed epileptics registered with a statutory disability insurance scheme. Results: Four cases of SUDEP were identified during the 18‐y period. The incidence of SUDEP was 4.3 per 10 000 patient‐years. All children showed polytherapy‐refractory epilepsy, developmental retardation and early‐onset epilepsy. Two witnessed cases had shown no previous signs of seizure.

Conclusion: SUDEP is rare in childhood. Children with uncomplicated epilepsy seem not to be at risk.
Sipping/lapping is a safe alternative feeding method to suckling for preterm infants
Authors: Mizuno Katsumi , Kani Keiko
Published: August 2010

Aim: To determine whether sipping/lapping is a safe alternative to suckle bottle‐feeding without any hydrostatic pressure, in terms of physiological stability and the relationship between swallowing and respiration. In addition, tongue movement was compared between sipping/lapping and suckling (bottle‐ and breastfeeding). Methods: Eighteen infants (30–35 wk of gestation at birth) were studied while sipping/lapping and suckling a bottle without any hydrostatic pressure at different feeding sessions on the same day of the first oral feeding. The postmenstrual age at the time of study was 34.6±0.2 wk. We evaluated the amounts ingested and administration times. The heart rate, O2 saturation (SpO2), and relationship between swallowing and respiration were examined while feeding. Tongue movements were also observed by ultrasonography. Statistical analysis was performed by a paired t‐test. Results: The amounts ingested and intake volume per minute were lower while sipping/lapping compared to suckling. The overall heart rate and SpO2 showed no statistically significant difference. The frequency of swallows followed by inspiration (27.6±0.8% and 31.0±1.3%) and swallows followed by expiration (46.4±0.9% and 45.4±1.4%, sipping and suckling, respectively) also showed no difference. Tongue movements while sipping/lapping differed from those while suckling a bottle or breast.

Conclusion: Because physiological parameters and the relationship between swallowing and respiration while sipping/lapping are comparable to those while suckle bottle‐feeding without any hydrostatic pressure, sipping/lapping is a safe alternative feeding method to suckle bottle‐feeding, even in preterm infants.
Well‐being among children and adolescents with mobility impairment in relation to demographic data and disability characteristics
Authors: Jemtä Lena , Dahl M , Fugl‐Meyer Kerstin S , Stensman Richard
Published: August 2010

Aim: To describe the well‐being of children and adolescents with mobility impairment in relation to demographic data and disability characteristics. Methods: The present study is based on interviews with 141 subjects aged 7 to 18 y with impaired mobility. Perceived overall well‐being was measured by a nine‐grade visual scale, the Snoopy scale. Independence or dependence was evaluated by the Index of Independence in Activities of Daily Living. Motor capacity was assessed with an instrument including active movements, rapidity, locomotion and balance as well as the presence and localization of pain. Results: Since there were no significant differences in well‐being regarding the diagnostic‐related group, additional disorder/disability or the degree of disability, the impairment per se did not necessarily influence well‐being negatively. Even though the majority of the children and adolescents in the study indicated a high level of well‐being, several risk factors for a lower level of well‐being were identified: greater age, not living with both parents, being a first‐generation immigrant, having an acquired disease/injury and experience of pain.

Conclusion: These findings increase our limited knowledge of well‐being among children/adolescents with mobility impairment and provide a basis for effective care and future research.
Unusual retrograde movement of a safety‐pin ingested by an infant
Authors: Gardikis Stefanos , Danielides Vassilios , Tsalkidis Aggelos , Vaos George , Chatzimicael Athanassios , Simopoulos Constantinos
Published: August 2010

Here we present the first reported case of an ingested open safety‐pin in a 7‐mo‐old boy that migrated from the stomach to the oesophagus.

Conclusion: This rare complication is probably due to a gastro‐oesophageal reflux effect, and for this reason we propose that all infants with safety‐pins and other sharp objects in the stomach should be positioned in a semi‐upright position.
Pediatrician's office: A solution in the prevention of childhood obesity
Authors: Bowman Shanthy A
Published: August 2010

A mother's ability to correctly perceive her child's weight status and her concern toward the overweight status of her child are important in the prevention of childhood obesity. Mothers should have adequate nutrition knowledge that enables them to plan and provide nutritious meals to their children.

Conclusion: Pediatricians may play a role in childhood obesity prevention interventions by helping mothers understand growth charts and by providing mothers with appropriate nutrition guidance for planning a balanced diet.
Human neutrophil lipocalin (HNL) as a diagnostic tool in children with acute infections: A study of the kinetics
Authors: Fjaertoft Gustav , Foucard Tony , Xu Shengyuan , Venge Per
Published: August 2010

Aim: To study the changes in blood of human neutrophil lipocalin (HNL) and C‐reactive protein (CRP) during the course of an acute infection in children. Methods: Children (n=92) hospitalized with symptoms and signs of acute infections were included and categorized into five groups, i.e. bacterial infection, suspected bacterial infection, viral infection, suspected viral infection and others. Blood was taken at admittance and the following 3–4 d for the measurement of CRP and HNL. Results: Both CRP and HNL were significantly raised at admittance in bacterial infection as compared to viral infection (p<0.001). After 25–48 h, 83% of the children with bacterial infections still had raised CRP levels in contrast to 11% having raised HNL levels. The levels of CRP, but not those of HNL, were significantly correlated to days of symptoms before admission.

Conclusions: HNL is a promising diagnostic tool in the distinction of acute infections caused by bacteria or virus. The differences in the kinetics of CRP and HNL make HNL a better marker for monitoring antibacterial treatment, since HNL is probably elevated only when an active bacterial infection is at hand.
Abnormalities in plasma fatty acid composition in human immunodeficiency virus‐infected children treated with protease inhibitors
Authors: Aldámiz‐Echevarría Luis , Pocheville Itziar , Sanjurjo Pablo , Elorz Javier , Angel Prieto Jose , Rodríguez‐Soriano Juan
Published: August 2010

Aim: To study plasma fatty acid composition in human immunodeficiency virus‐infected children treated with protease inhibitors and its relation with other components of the metabolic syndrome observed after this therapy. Design: Cross‐sectional study from collected clinical database. Subjects: 17 children with HIV infection treated with protease inhibitors. Nine patients received ritonavir (20–30 mg/kg/d) and the remaining eight received nelfinavir (60–90 mg/kg/d). Duration of protease inhibitors treatment was 711±208 d. As controls, we used 112 matched blood samples from apparently healthy children admitted for minor surgical procedures. Methods: Plasma fatty acids were determined using a Hewlett Packard GC 5890 gas chromatograph. Results: Plasma levels of cholesterol and triglycerides and insulin‐like growth factor 1 (IGF‐1) tended to be high in protease inhibitor‐treated patients. Plasma content of ω6 long‐chain polyunsaturated fatty acids and, in particular, of the highly unsaturated 22∶4ω6 and 22∶5ω6, was significantly increased. Also, infected children had increased Δ6 and Δ4 desaturase activities and decreased Δ5 desaturase activity. Significant correlations were present between plasma IGF‐1 level and plasma triglycerides, plasminogen activator inhibitor‐1 activity and Δ6 desaturase activity.

Conclusion: HIV‐infected, protease inhibitor‐treated children exhibit a metabolic syndrome which is associated with significant changes in plasma fatty acid composition. These changes are similar to those observed in situations of insulin resistance and are linked to variations in plasma IGF‐1 concentration.
The effect of oral L‐carnitine supplementation on the lipid profiles of hyperlipidaemic children
Authors: Güneş B , Songül Yalçin S , Kalkanoğlu HS , Önol S , Dursun A , Coşkun Turgay
Published: August 2010

Aim: To investigate the carnitine status and the effect of carnitine supplementation on serum lipid profiles in children with hyperlipoproteinaemia, a clinical open trial was conducted at Hacettepe University Ihsan Dogramaci Children's Hospital, Section of Nutrition and Metabolism. Methods: Patients were given carnitine at a dose of 100 mg/kg/d for 12 wk. Blood samples for the determination of lipid profile and carnitine levels and urine samples for carnitine levels were obtained on admission, at week 4 and week 12 of the study period. Results: A total of 41 children were enrolled in the study: 20 patients had type II heterozygotes, eight patients had type II homozygotes, three patients had type III, six patients had type V and four patients had secondary hyperlipidaemias. Serum and urine carnitine levels were within normal limits on admission. No significant correlations were found between serum carnitine levels and serum lipid profiles. Serum HDL and apolipoprotein A‐I decreased significantly during the 12 wk of intervention in type II heterozygotes. In type II homozygotes, total cholesterol and LDL levels at weeks 4 and 12 increased significantly compared to initial levels. No significant change was noted for lipid parameters in hyperlipoproteinaemia type V.

Conclusion: The results of this trial demonstrated that carnitine supplementation was of no benefit for children with hyperlipidaemias, especially in primary hyperlipoproteinaemia type II heterozygotes, homozygotes and type V.
Risk factors for venous thrombosis in Swedish children and adolescents
Authors: Rask Olof , Berntorp Erik , Ljung Rolf
Published: August 2010

Aim: To identify prothrombotic risk profiles in children and adolescents referred to a regional coagulation centre in southern Sweden for a first thrombotic event. Methods: One hundred and twenty‐eight consecutive children and adolescents (newborn to 20 y) referred for evaluations of a first episode of venous thrombosis were investigated. Clinical data were collected retrospectively, and the following variables were investigated: protein C, protein S, antithrombin; resistance to activated protein C; the genotypes FV‐G1691A, F II‐G20210A, MTHFR‐C677T, MTHFR‐ A1298C; coagulation factors VIII and XI. Results: 104/128 subjects (81%) had identifiable acquired risk factors, most often indwelling catheters and hormone therapy. Predisposing genetic factors related to thromboembolic events were revealed in 53/83 (64%) of subjects who agreed to follow‐up blood sampling, and 17/83 (20%) had two or more inherited risk factors. Combinations of genetic and acquired risk factors were identified in 45/83 (54%) of the subjects, and 77/83 (93%) had at least one such risk factor. Both sexes had one peak in frequency at less than 1 y of age and then an increase during adolescence, more in females than in males. Plasma values for coagulation factors VIII and XI were age appropriate and showed a normal Gaussian distribution.

Conclusion: This study identified prothrombotic risk profiles in almost all children and adolescents with venous thrombosis, which underlines the importance of careful evaluation of genetic and acquired risk factors.
Spirometry and lung function in children with congenital deafness
Authors: Jonsson Östen , Gustafsson Dan
Published: August 2010

Aim: Deaf children do not develop a verbal language and will therefore not experience normal changes in airway pressure produced by speech. The impact on lung development of factors such as talking and screaming has not previously been investigated. Method: We performed spirometry in 51 children with congenital deafness without other medical problems and compared the results with 82 healthy hearing controls. Results: The deaf children had poorer spirometry results. They participated in the spirometry manoeuvre with less enthusiasm than the controls. This was due to difficulty in giving non‐verbal instructions in an enthusiastic way. When comparing only those in the two groups whose participation in the spirometry testing was evaluated as very good, poorer results were nevertheless obtained by the deaf group.

Conclusion: We conclude that spirometry instructions for deaf children must be improved. Furthermore, a positive effect on lung development through use of the lungs for speech and screaming cannot be excluded.