bluuebunny/crossref_metadata_2025 huggingface dataset:
Can daily repeated doses of orally administered glucose induce tolerance when given for neonatal pain relief?
Authors: Eriksson M , Finnström O
Published: August 2010

Aim: Orally administered sweet solutions have a pain‐relieving effect during painful procedures in newborn infants. The underlying mechanism is not fully understood, but, from the results of animal research, an opioid‐like mechanism is often suggested. The aim of this study was to determine whether repeated doses of orally administered glucose would cause tolerance to glucose. Methods: Fifty‐seven healthy, full‐term infants were recruited on the day of birth to receive three daily doses of either 1 ml 30% glucose or sterile water for 3–5 d, after which routine blood samples were collected by heel‐lance. All infants received 1 ml 30% glucose before the heel‐lance was carried out. Crying time, Premature Infant Pain Profile scores and changes in heart rate were used as pain measures. Results: No differences were found between the groups, either in demographic data or in the outcome variables.

Conclusion: No tolerance was observed under the conditions prevailing in this study. However, we cannot rule out an endogenous opioid mechanism. What is clinically important is that repeated doses of glucose do not decrease the pain‐relieving effect.
The abdominal circumference to weight ratio increases with decreasing body weight in preterm infants
Authors: Mihatsch WA , Högel J , Pohlandt F
Published: August 2010

Abdominal distension is one of the major clinical indications to withhold feedings in preterm infants. The abdominal circumference (AC) was measured in 42 premature infants on full enteral nutrition in order to establish reference values. AC decreased linearly (r2= 0.83) with decreasing weight. However, the AC to weight ratio increased substantially (hyperbolically) with decreasing weight.

Conclusion: The increased AC to weight ratio may be misinterpreted as pathological abdominal distension in the clinical assessment of preterm infants on full enteral nutrition.
Trichobezoar in a child with concomitant coeliac disease: a case report
Authors: Larsson LT , Nivenius K , Wettrell G
Published: August 2010

We report on a case of childhood coeliac disease presenting with tricophagia and trichobezoar. The combination of obstructive symptoms, severe hypoalbuminaemia and a large abdominal mass detected on CT scan warranted diagnostic gastroscopy and laparotomy, resulting in removal of a large gastric trichobezoar. Surgical recovery was uneventful although serologic studies for coeliac disease were abnormal. Coeliac disease was confirmed by subsequent biopsy.

Conclusion: Concomitant trichobezoar and coeliac disease in a child is reported for the first time. It is postulated that the trichobezoar was a result of coeliac disease‐induced pica.
Homozygous hypercholesterolaemia and ezetimibe: a case report
Authors: Hendriksz CJ , Norbury G , Tabrah S , Taylor A , Humphries SE
Published: August 2010

A girl of Indian origin presented with unusual nodules on her hands, and total cholesterol was found to be >25 mmol/L. The girl had “mild” P664L mutation and total cholesterol levels fell by 38% when she was on a diet and statin therapy. A further reduction of 26% in total cholesterol and 37% in low‐density lipoprotein (LDL) was achieved by adding ezetimibe to the treatment.

Conclusion: A case of homozygous hypercholesterolaemia is reported in order to highlight treatment options such as liver transplantation, LDL‐aphaeresis and treatment with ezetimibe.
The art and science of hydration
Authors: Kleiner SM
Published: August 2010

It is understood that water is the most essential nutrient for life, yet research elucidating the fine points of hydration and fluid needs is still in its youth. Public recommendations based on scientific evidence are not always translated by the media into useful and practical guidelines.

Conclusion: Further research investigating the benefits of all fluids, and water in particular, as beverages to meet hydration and health needs will help clarify the controversies over how much water we should drink every day. Health practitioners must further work to assist patients with designing practical fluid intake strategies to ensure adequate hydration.
The biological significance of skin‐to‐skin contact and maternal odours
Authors: Porter RH
Published: August 2010

Infant‐mother bodily contact is believed to be the species‐typical pattern of immediate postpartum child care. Mothers and newborns engage in mutually beneficial interactions. Maternal odours stimulate breastfeeding activity and are implicated in individual recognition.

Conclusion: Skin‐to‐skin contact and exposure to maternal odours facilitate infants’adaptation to the early postnatal environment.
Extrauterine growth restriction in very‐low‐birthweight infants
Authors: De Curtis M , Rigo J
Published: August 2010

Postnatal growth failure of very‐low‐birthweight (VLBW) infants may result from a complex interaction of genetic and environmental factors, including inadequate nutrition, morbidities affecting nutrient requirements, endocrine abnormalities and treatments. Among VLBW infants, those small for gestational age (SGA) at birth and those with postnatal growth restriction at the time of discharge are at higher risk of later growth failure and long‐term consequences. Nutritional intervention with an “aggressive nutrition” during the first weeks of life may be able to minimize the interruption of nutrients that occurs at birth, and reduce as much as possible the incidence of growth restriction at the time of discharge and later. Even though aggressive parenteral and enteral nutrition appear to be effective and safe in VLBW infants, further evaluations of their long‐term effect on growth and health consequences are needed. Several studies evaluating the effect of enriched nutrient formulas after hospital discharge on growth and neurodevelopment have produced conflicting results, whereas the potential deleterious long‐term effects of prolonged use of high protein and/or of later catch‐up growth have been questioned. In contrast, recent data seem to indicate that the use of human milk after hospital discharge could be the most beneficial diet for subsequent health and development.

Conclusion: VLBW infants SGA at birth and those with early postnatal growth restriction are at high risk of later growth failure and long‐term consequences. Therefore, the first objective of early nutrition should be to reduce the incidence of growth restriction at the time of discharge. Further studies on VLBW infants to evaluate the safety and beneficial effects of prolonged dietary manipulation during the first year of life are needed.
Determination of oxidative status in breast and formula milk
Authors: Turoli D , Testolin G , Zanini R , Bellù R
Published: August 2010

Aim: To investigate to what extent formula milk and stored breast milk, commonly used in hospitals, could be pro‐oxidant sources for newborn babies. Methods: We determined total anti‐oxidant capacity and lipid peroxidation products, such as lipid peroxides, TBARS and conjugated dienes, in fresh and stored (at ‐20°C) samples of breast milk and in different brands of formula milk. Results: There were notable differences in the oxidation parameters in several brands of formula milk, particularly concerning the levels of lipid peroxides and total antioxidant capacity. No difference was found in the mean total antioxidant capacity between formula and breast milk, even if the vitamin content is much higher in formula milk than in breast milk. On the contrary, all the considered lipid peroxidation products were higher in human milk (HM) than formula milk (FM), and lipid peroxides were much higher in HM stored at ‐20°C. Many differences were found between different formula milks.

Conclusion: There was a conspicuous formation of lipid peroxides in HM stored at ‐20°C, which was probably caused by an increased presence of free fatty acids due to lipoprotein lipase activity during storage. Unexpectedly, even fresh HM had a higher concentration of lipid peroxidation products when compared to FM. This could be ascribed to the higher susceptibility of HM to degradation during analysis because of manipulation and light exposure. However, it is also interesting that the high content of lipid peroxides did not correspond to a low total antioxidant capacity in either breast or formula milk. This could signify that such levels of lipid peroxidation products might be present naturally in milk and HM after expression is subject to a strong peroxidation either at room temperature or at ‐20°C.
Prevalence trends of obesity and overweight among 10‐year‐old children in western Sweden and relationship with parental body mass index
Authors: Mårild S , Bondestam M , Bergström R , Ehnberg S , Hollsing A , Albertsson‐Wikland K
Published: August 2010

Aim: To determine the regional prevalence, secular and family‐related trends of obesity and overweight among 10‐y‐old children. Methods: A cross‐sectional study of 10‐y‐old children, born in 1990, was performed during September 2000 to June 2001 at school health centres in three communities in the western part of Sweden. Evaluation was performed in 6311 children, or 81% of the target population. Data from a cohort of children, born in 1974, who form the national growth charts, were available for comparison. Results: The mean body mass index was 17.9 kg/m2 in 10‐y‐old children born in 1990 and 17.0 kg/m2 for 10‐y‐olds born in 1974 (p < 0.0001). Of the 10‐y‐old children in 2000–2001, born in 1990, 18% were overweight and 2.9 % obese, which corresponds to a twofold increase in presence of overweight and a fourfold increase in presence of obesity among 10‐y‐old children from 1984 to 2000. There was a significant correlation between parental and child body mass index. The prevalence of obesity and being overweight appeared to be higher in children whose parents did not participate in the study.

Conclusion: During a 16‐y period, from 1984 to 2000, a twofold increase in being overweight and a fourfold increase in obesity were seen among 10‐y‐old children in the western part of Sweden. Parental ponderosity or reluctance to participate in the study was related to a higher prevalence of being overweight or obese in the children. There is a need for the healthcare system to recognize the threats to the health of the population of this new “epidemic” and initiate preventive measures and treatment programmes.
Cognitive function at 10 years of age in children who have required neonatal intensive care
Authors: Schermann L , Sedin G
Published: August 2010

Aim: To study cognitive function at 10 y of age in a cohort of children who required neonatal intensive care within the Uppsala Neonatal Follow‐up Study. Methods: 226 children, who were born in 1986–1989 and had required neonatal intensive care (NIC) and 72 full‐term, healthy control children were enrolled in the study. NIC children were grouped according to gestational age (group I, 23–31 wk; subgroup IA, 23–27 wk; IB 28–31 wk; group II, 32–36 wk; group III, >36wk), with infants with congenital malformation (IWCM) included and excluded from the main groups. The Kaufman Assessment Battery for Children (K‐ABC) was administered and results were analysed in relation to the K‐ABC global scales: sequential, simultaneous, mental processing composite and achievement. Results: The great majority of children had well‐developed cognitive function, reaching scores at an average level or above. When groups were compared, full‐term children that required NIC (group III) showed lower scores than controls on all scales measured by the K‐ABC. Preterm children from all the studied groups (groups IA, IB, II) showed poorer performance than controls in the simultaneous processing scale, and group IA scored lower than controls in the achievement scale. The incidence of major cognitive impairment (IQ <70) was low in NIC children (<5%), but children from group IA showed significant higher frequency of impairment in the simultaneous, mental processing composite and achievement scales. Children from group IA presented a high frequency of discrepancy between the K‐ABC scales, with lower simultaneous and higher sequential scores. Analysis with IWCM excluded from the main groups revealed identical results.

Conclusion: Most children who needed neonatal intensive care had developed well their cognitive function at 10 y of age. The long‐term effect of neonatal intensive care on cognitive function was more evident in extremely preterm infants (group IA), especially in tasks involving simultaneous ways of processing information.
Mother‐infant skin‐to‐skin contact after delivery results in early recognition of own mother's milk odour
Authors: Mizuno K , Mizuno N , Shinohara T , Noda M
Published: August 2010

Aim: To determine the effects of mother‐infant skin‐to‐skin contact immediately after birth on infant recognition of their own mother's milk odour and breastfeeding duration until 1 y of age. Methods: Sixty healthy, full‐term neonates were randomly assigned to group A with skin‐to‐skin contact and group B without. One and 4d after birth, infant responses to the following odour stimuli were observed: own mother's milk, another mother's milk, formula, orange juice and distilled water. Infant facial action was videotaped and the frequency of mouthing movements was evaluated for each stimulus. Nutritional assessment, focused particularly on breastfeeding, was performed every 3 mo on participating infants. Statistical analysis comparing the frequency of mouthing movements with the aforementioned five different odour exposures was performed by ANOVA with Fisher's PLSD. Kaplan‐Meier analysis with a log‐rank test was used to compare breastfeeding rates between groups. Results: Infants in both groups responded differently to mother's milk odour (either their own or another mother's milk) compared to the other stimuli on days 1 and 4. However, infants in group A demonstrated a larger difference in mouthing movements between their own and another mother's milk odour at 4 d of age (2.6 ±; 1.6) compared to infants in group B (0.9 ±; 2.0, p= 0.01). Infants in group A were breastfed an average of 1.9 mo longer than the others.

Conclusion: Our study provides evidence that mother‐infant skin‐to‐skin contact for more than 50 min immediately after birth results in enhanced infant recognition of their own mother's milk odour and longer breastfeeding duration.
The life situation of parents over the first year after their child's cancer diagnosis
Authors: Lähteenmäki PM , Sjöblom J , Korhonen T , Salmi TT
Published: August 2010

Aim: To evaluate the impact of childhood cancer on the life of the parents. Method: A 1‐y follow‐up study, with two time points for questionnaires, was completed in 21 out of 26 eligible families, and there were 46 control families matched by mothers’educational status. Results: Half of the mothers worked outside home during the first year of their child's illness. The perceived amount of lost family income was high during the first few months. The attitudes of the parents were fairly positive as their family life and spouse relations were concerned. Feelings of being under strain or stressed were, by the mothers, described as intolerable in the beginning. However, standardized anxiety assessment failed to show an increase in feelings of anxiety. Own health was rated significantly negative by cancer parents.

Conclusions: Despite good family relationships, a need for supportive measures exists, especially during the first few months, and in‐depth interviews by psychologists or special nurses might be a way of finding out possible anxiety. The perceived feelings of own health may also be an indicator of the level of distress. Parent support groups could also do more to offer opportunities of physical activities for the parents, not merely disease‐related information and group discussions.
The world's children—the children's world1
Authors: Hofvander Y
Published: August 2010

I feel very honoured to have been selected for the Nils RoséN von Rosenstein award. My thanks are due to the Swedish Paediatric Society.
Caring for the health and medical and emotional needs of children of migrants and asylum seekers
Authors: Gracey M
Published: August 2010

Political turmoil, military conflicts and other international sociological upheavals are causing significant immigration of large numbers of people, including infants and children, in Europe. Many of these young migrants are refugees. These youngsters have significant health needs, and medical conditions (such as infectious diseases) and mental health problems due to their previous stressful situations and the difficulties that they often experience while settling, even temporarily, into their new environments. Government authorities must screen for transmissible diseases and ensure that vaccine‐preventable infections are adequately covered. Paediatricians must give the best possible care for these children and act as their advocates. This can be enhanced by collaborating with national and international paediatric societies and with international non‐government agencies. This problem is not confined to Europe; world‐wide, it occurs on a massive scale and causes huge burdens for poorer countries that have serious difficulties in coping with the extra financial, personnel and infrastructure needs imposed by massive, uncontrolled migration of populations that are often unhealthy and inadequately nourished. However, this should not be used as a pretext to deny safe refuge to children and their families who need it.

Conclusion: Massive movements of infant and child immigrants and refugees across European borders over recent years have brought challenges to paediatricians because of the needs for the health and medical and mental health care of these young people. Paediatricians have an important role in their care and by acting, wherever possible, as their advocates. This is a massive problem, world‐wide, in which paediatricians can have a potentially significant positive impact.
Final height after combined growth hormone and GnRH analogue treatment in adopted girls with early puberty
Authors: Tuvemo T , Jonsson B , Gustafsson J , Albertsson‐Wikland K , Aronson AS , Häger A , Ivarson S , Kriström B , Marcus C , Nilsson KO , Westgren U , Westphal O , Aman J , Proos LA
Published: August 2010

Background: Girls adopted from developing countries often have early or precocious puberty, requiring treatment with gonadotrophin‐releasing hormone (GnRH) analogues. During such treatment, decreased growth velocity is frequent. Aim: To study whether the addition of growth hormone (GH) to GnRH analogue treatment improves final height in girls with early or precocious puberty. Methods: Forty‐six girls with early or precocious puberty (age ± 9.5y) adopted from developing countries were randomized for treatment for 2–4 y with GnRH analogue, or with a combination of GH and GnRH analogue. Results: During treatment, the mean growth velocity in the GH/GnRH analogue group was significantly higher compared to the control group. Combined GH/GnRH analogue treatment resulted in a higher final height: 158.9 cm compared to 155.8 cm in the GnRH analogue‐treated group. Three out of 24 girls (13%) in the combined group and nine of the 22 girls (41%) treated with GnRH analogue alone attained a final height below –2 standard deviation scores (SDS).

Conclusion: The difference between the two groups is statistically significant, and possibly of clinical importance. A future challenge is to identify a subgroup with clinically significant advantage of GH addition to GnRH analogue treatment. Being very short on arrival in Sweden and being short and young at start of treatment are possible indicators.
Are regulatory problems in infancy precursors of later hyperkinetic symptoms?
Authors: Becker K , Holtmann M , Laucht M , Schmidt MH
Published: August 2010

Aim: To examine whether regulatory problems in infancy predict later hyperkinetic symptoms in childhood and pre‐adolescence. Methods: In a prospective longitudinal study of 319 children at risk of later developmental problems and psychopathology, hyperkinetic behaviour problems were assessed at the ages of 2, 4.5, 8 and 11 y by means of a standardized parent interview. Infant regulatory problems at the age of 3 mo were determined from multiple sources of information. An observational procedure was used to assess the quality of mother‐infant interaction. Results: At the age of 3 mo, 17% of the infants (n= 55; 27 boys, 28 girls) suffered from multiple regulatory problems. Compared to a control group (n= 264), these children presented more hyperkinetic symptoms throughout childhood. Negativity in the mother‐infant interaction and early family adversity each contributed to later hyperkinetic symptoms. When controlling for family adversity, the association between infant multiple regulatory problems and later hyperkinetic problems was rendered insignificant.

Conclusions: These findings suggest that multiple regulatory problems may not be a key variable for later hyperkinetic problems. The impact of early family adversity factors clearly outweighed that of infant psychopathology on later behaviour disorder.
The value of Bilicheck as a screening tool for neonatal jaundice in term and near‐term babies
Authors: Samanta S , Tan M , Kissack C , Nayak S , Chittick R , Yoxall CW
Published: August 2010

Aims: To determine the accuracy of Bilicheck in assessing serum bilirubin. To evaluate the effectiveness of Bilicheck as a screening device in a population of jaundiced term and near‐term babies. Methods: Prospective evaluation of paired Bilicheck measurements and serum bilirubin in 300 babies. Results: There was a strong correlation between Bilicheck and serum bilirubin. The mean difference between Bilicheck and serum bilirubin was —10.7 μmol/l, but the 95% limits of agreement were wide at —80 μmol/l to +60 μmol/l. Bilicheck identified significant jaundice (serum bilirubin above 250 μmol/l) with a sensitivity (95% confidence interval) of 91% (88% to 94%) and specificity of 66% (60% to 71%). The area under the receiver operator characteristic curve was 0.85. There were five false negatives, all of whom had a serum bilirubin below 300 μmol/l. If Bilicheck had been used as a screening device, there would have been a 55% decrease in blood samples taken in these babies.

Conclusion: Bilicheck cannot be used to measure serum bilirubin in term and near‐term babies with jaundice, but is an effective screening method, which can be used to safely reduce the number of blood tests in these babies.
Assessment of jaundice in preterm neonates: comparison between clinical assessment, two transcutaneous bilirubinometers and serum bilirubin values
Authors: Szabo P , Wolf M , Bucher HU , Haensse D , Fauchère JC , Arlettaz R
Published: August 2010

Aim: 1) To compare the clinical assessment of craniocaudal progression of jaundice and two transcutaneous bilirubinometers with serum bilirubin values in preterm neonates; 2) to identify factors affecting the difference between non‐invasive bilirubin estimation and serum bilirubin. Methods: Serum bilirubin was clinically estimated in healthy preterm newborn infants (34 to 36.9 gestational weeks) independently by a primary investigator and by nurses, and subsequently compared with separate measures of two transcutaneous bilirubinometers. Results: A total of 107 measurements were performed on 69 infants. Minolta JM‐102 showed the best performance, with ROC area under the curve of 0.96, followed by BiliCheck™ over the sternum (0.89) and over the forehead (0.88), clinical assessment by nurses (0.73) and by a physician (0.70). Serum bilirubin <190 μmol/l can be detected with 95% sensitivity with Minolta JM–102 ≫19 units, with BiliCheck™≫145 μmol/l over the sternum and ≫165 μmol/l over the forehead and with jaundice progression to the trunk or further (Kramer zone ≫2). Gestational age affects all non‐invasive methods in the estimation of serum bilirubin, whereas skin colour affects both BiliCheck™ and clinical assessment. Ambient light affects only clinical assessment.

Conclusion: Minolta JM‐102 showed the best performance, closely followed by BiliCheck™, with clinical assessment performing far worse than either transcutaneous method. None of the three methods are recommended as complete substitutes for serum bilirubin values in jaundiced preterm infants.
Parent‐completed developmental screening in a Norwegian population sample: a comparison with US normative data
Authors: Janson H , Squires J
Published: August 2010

Aim: To compare normative data of a Norwegian translation of the Ages and Stages Questionnaires with original US normative data. Methods: Norwegian‐born mothers randomly selected from the population register completed Norwegian translations of the Ages and Stages Questionnaires, a series of 19 age‐specific child development screening questionnaires each made up of 30 items in five domains: Communication, Gross Motor, Fine Motor, Problem Solving, and Personal‐Social. Domain score group differences with original US normative data on 10 age‐specific questionnaires (for ages 4, 8, 12, 16, 20, 24, 30, 36, 48, and 60 mo) were investigated. The Norwegian data consisted of 1341 children, varying between 82 and 176 per age interval. Results: On the whole, parents' reports of their children's development were very similar in the two data sets. Only five out of 50 mean comparisons revealed a mean difference either greater than a Cohen's d of 0.5 or greater than the smallest increment on a domain score. The variation in scores tended to be somewhat smaller in the Norwegian sample.

Conclusion: It seems reasonable to expect that domain scores on the Ages and Stages Questionnaires may be interpreted in the same way in Norway and the United States, and these results may also generalize to other Western settings. These findings from a true random sample also increase the confidence in the original normative data.
Recurrent abdominal pain in school children revisited: fitting adverse food reactions into the puzzle
Authors: Størdal K , Bentsen BS
Published: August 2010

The diagnostic work‐up of children seeking health care because of recurrent abdominal pain is a clinical challenge. Food hypersensitivity might be one of the aetiologies behind this symptom. Neither the understanding of possible immune mechanisms nor endoscopic or histological findings have yet contributed to reliable diagnostic tests.

Conclusion: The possibility of adverse food reactions should be evaluated among other abnormalities behind recurrent abdominal pain in children. Still, the diagnosis of immune‐mediated food reactions depends on open or blinded food challenge.
Behavioral and learning problems in schoolchildren related to cognitive test data
Authors: Volkmar FR , Klin A
Published: August 2010

The interface between disorders of learning and development and disorders of behavior presents challenges for researchers and clinicians alike. In the Elk et al. paper, a large group of children were screened for learning and/or behavioral problems. A relatively large number of children screened positive and their IQ scores were analyzed using a cluster analytic approach. Various patterns were identified including lower and higher functioning children. In our commentary, we point out the challenges for diagnosis of mental health problems in both lower and higher functioning children; the potential overlap of problems in learning and social interaction remains an area in need of additional work.

Conclusion: There is a complex interaction between developmental status and behavioral difficulty; further research is needed to clarify diagnostic validity and areas where existing diagnostic systems need further refinement.
Onset of puberty at eight years of age in girls determines a specific tempo of puberty but does not affect adult height
Authors: Llop‐Viñolas D , Vizmanos B , Monasterolo R Closa , Subías J Escribano , Fernández‐Ballart JD , Martí‐Henneberg C
Published: August 2010

Aims: To analyse the effect of early puberty (onset between 7.5 and 8.5 y) on pubertal growth and adult height in girls, and the implications of this effect for the age limit for normal onset of puberty. Methods: Longitudinal study in Reus (Spain) of 32 girls with early puberty until they reached adult height. Data from these girls were compared with longitudinal data from girls (116) from the same population with normal onset at 10 (n= 37), 11 (n= 47), 12 (n= 19) and 13 (n= 13) y. We analysed height, target height, adult height, pubertal height increase, duration of pubertal growth, age at menarche and time to menarche. Results: The adult height of girls with early puberty (160.9 ± 5.4 cm) was similar to that of girls with onset at later ages (p= not significant). In these girls, puberty lasted 5.4 ± 0.7 y and the mean growth during puberty was 31.1 ± 3.5 cm. As the age of onset of puberty increases, the duration of puberty and mean growth during puberty progressively decreased (p < 0.001). Girls with early puberty reached menarche at a mean age of 10.9 ± 1.0 y, 3.2 ± 0.9 y after onset of puberty, and this time span was greater than in the other groups.

Conclusion: Girls with onset of puberty at 8 y show all the compensatory phenomena related to height at onset, pubertal duration and height increase during puberty. These phenomena cause their adult height to be similar to that of girls who begin puberty at the age of 10 to 13 y.
Adaptation of reaching movements in children and young adults with myelomeningocele
Authors: Norrlin S , Rösblad B
Published: August 2010

Aim: To investigate the ability to adapt reaching movements to new visuomotor gain conditions in subjects with myelomeningocele (MMC) and subjects without disabilities. In addition, differences in movement error within the MMC group were investigated. Methods: Thirty subjects with myelomeningocele, 9–19 y, and 30 subjects without disabilities were included in the study. Data were collected with a digitizing tablet linked to a computer. The subjects made reaching movements towards three targets at different distances displayed on the computer screen, and movements were carried out under two different gain conditions—a base condition and an altered condition. Adaptation was quantified from the extent error and expressed in percentage of the target distances. For statistical analysis, ANOVA and t‐tests were used. Results: Under the base condition, no statistically significant difference between the groups was found, but after the first gain change, the MMC group evinced larger percentage error compared to the control group (p= 0.005). Analysis showed that the subjects in the MMC group did not fully adapt their movements under the altered condition after several trials of practice, but in the control group movements were rapidly adapted to the new gain. Subjects with early and severe symptoms of brainstem dysfunction showed a dramatic increase in error variability under the altered condition, while subjects who had shunt‐treated hydrocephalus did not have larger percentage error compared to the others.

Conclusion: Motor adaptation of reaching movements was impaired in subjects with MMC, but short‐term motor learning did also occur in the MMC group.
Reduced case fatality among hospitalized children during a war in Guinea‐Bissau: a lesson in equity
Authors: Sodemann M , Veirum J , Biai S , Nielsen J , Bale C , Jakobsen M Skytte , Gustafson P , Aaby P
Published: August 2010

Background: During a recent armed conflict in Guinea‐Bissau, we observed a marked decline in the case fatality among hospitalized children at the only paediatric department in the country. Aim: To analyse the causes behind the observed fall in case fatality. Material: All children hospitalized at the only paediatric department in the capital of Guinea‐Bissau. The war cohort comprised all children hospitalized during the war, which lasted from June 1998 to May 1999, and the peace cohort comprised all children hospitalized in the year preceding the war. As part of a longitudinal community study, we also registered all children being hospitalized from the Bandim Health Project's study area, including routinely collected information on socio‐economic background factors. Methods: The war cohort was compared with the peace cohort in terms of determinants for hospital case fatality. Through information in the community register, we examined post‐hospital mortality in the 2 wk after discharge as well as socio‐economic differences in recruitment during the war. Hospital case fatality was estimated by odds ratios and compared by multiple logistic regression. Community mortality risk was estimated by deaths per person years. Results: The case fatality among children aged 0–14 y fell during the war (age‐adjusted OR = 0.58; 95%CI: 0.50–0.68). There was a uniform reduction in case fatality among children hospitalized less than 7 d, while we observed no decline among children hospitalized longer. There were more children per bed during the war and mean hospitalization time was shorter, and post‐discharge mortality also fell (mortality ratio (MR) = 0.57; 95%CI: 0.40–0.83). Adjustment for socio‐economic con‐founders in recruitment during the war period made no difference to the estimated decline in case fatality. The decline in case fatality at the hospital was not explained by a general decline in mortality. Compared with the preceding year, the mortality ratio was 1.34 (1.20–1.51) in the Bandim Health Project's study area during the war. Adjusted for age, the decline in case fatality at the hospital was most marked for disadvantaged groups. For example, the general reduction in case fatality was 42% (95%CI: 11–63); however, children of mothers without any schooling experienced a reduction of 73% (95%CI: 27–90%), whereas the reduction was only 33% (95%CI: 14–61%) for children of mothers with school education.

Conclusion: The decline in case fatality could be explained neither by a general decline in childhood mortality nor by changes in recruitment or discharge policy. The decline was therefore most likely due to improved treatment as a result of better availability of drugs funded by humanitarian aid and the presence of dedicated staff, which was offered relief food as compensation. Interventions improving case management may have a proportionately larger effect for poor families.
“White dots on the placenta and red dots on the baby”: congential cutaneous candidiasis—a rare disease of the neonate
Authors: Diana A , Epiney M , Ecoffey M , Pfister RE
Published: August 2010

Cutaneous congenital candidiasis (CCC) is a very rare disease of the term or premature infant consisting of a generalized rash at or shortly after birth usually without other signs or symptoms. The presence of white microabscesses on the placenta and umbilical cord of an infant with such a rash must suggest the diagnosis of CCC, which is always secondary to Candida chorioamnionitis but may pass unrecognized. Despite the high prevalence of vulvo‐vaginitis in pregnant women, Candida chorioamnionitis is rare and CCC remains apparently extremely rare with just some hundred cases described. However, as the condition is essentially benign and self‐limited, underdiagnosis is likely. As occasional systemic spread of Candida infection is described and maternal complications may arise, diagnosis and a close follow‐up or treatment is of importance. We present two cases of CCC, stressing the importance of sharing clinical findings between obstetrician and neonatologist for the diagnosis and subsequent management.
Clinical and morphological features of paediatric myelodysplastic syndromes: a review of 34 cases
Authors: Polychronopoulou S , Panagiotou JP , Kossiva L , Mavrou A , Anagnostou D , Haidas S
Published: August 2010

Background: The clinical and morphological spectrum of myelodysplastic syndromes (MDS) during childhood has not yet been completely documented. We herein present the clinical features and morphological data from peripheral blood (PB), bone marrow aspirates (BMA) and bone marrow biopsies (BMB) of a series of paediatric MDS patients, with particular emphasis on their specific morphological characteristics and their diverse underlying genetic background. Patients and methods: Thirty‐four patients with MDS (median age 8.45 y) were consecutively diagnosed and treated during a period of 15 y (1988–2002). Diagnosis was based on clinical manifestations, morphology of PB, BMA and BMB, and cytogenetic analysis of BM cells. Clonogenic methyl‐cellulose cell cultures were performed in 23/34 patients. Patients were categorized into group A [26 primary/de novo MDS, i.e. refractory anaemia (RA) 18, RA with excess of blasts (RAEB) 2, RAEB in transformation (RAEB‐t) 6] and group B (8 secondary MDS, i.e. RA 4, RAEB 1, RAEB‐t 3). Treatment options varied according to protocols active during the period of the study and the availability of a suitable BM donor. Survival probabilities were estimated using the Kaplan‐Meier method. Results: Dysplastic features of the erythroid, myeloid and megakaryocytic lineage were detected at BMA in 85%, 50% and 90% of the patients, respectively, while decreased cellularity was found at BMB in 21/34 patients (60%). RA patients of group A presented at BMB significant hypocellularity (14/18) as a prominent finding due to decrease of the myeloid (13/18 patients) and/or the megakaryocytic (14/18 patients) lineage. Hypocellularity in RA was accompanied by dysplasia of the erythroid (17/18 patients) and megakaryocytic (16/18 patients) lineage, the presence of abnormal localization of immature precursors (ALIP, 8/18 patients), fibrosis (5/18) and stromal changes (11/18). Chromosomal aberrations were revealed in 17/34 patients, of which monosomy 7 was present in seven. Cell cultures demonstrated abnormal myeloid and/or erythroid in vitro clonal growth pattern in all the examined patients. An associated disorder or inherited disease, was identified in 14/26 patients (54%) with primary MDS. Cumulative survival of group A patients was 44.2% (RA 66.6%, RAEB/RAEBt 14.6%; p= 0.001), and of the whole group 42.4%, at 14 y.

Conclusions: Hypocellularity of significant degree is a constant and prominent feature among paediatric MDS, especially those with RA. A large variety of associated disorders underlies the clinical appearance of paediatric MDS, reflecting their marked heterogeneity. RA represents the prominent subtype during childhood (69% in this study), and it appears to have the best prognosis, while prognosis of RAEB/RAEBt remains extremely poor.
Wholehearted life support of babies born at 23 weeks of gestation
Authors: Greisen G
Published: August 2010

Justification of life support by all means to babies born at 23 wk of gestation.

Conclusion: Depends upon the needs and wants of the family.
Effect of BCG vaccine on tuberculin skin tests in 7–11‐year‐old children
Authors: Bozaykut A , Atay E , Sevim H , Atay Z , Ceran O
Published: August 2010

Aim: To determine the effect of Bacillus Calmette Guerin (BCG) vaccination on tuberculin skin test responses in 7–11‐year‐old children, and also to clarify whether the number of vaccinations and the time interval between vaccination and tuberculin skin test have an effect on the test responses. Method: 1200 primary school children were evaluated for the presence and number of BCG scars. They were then given 5 TU PPD‐S intra‐dermally. Seventy‐two hours after the application of tests, PPD indurations were measured. Results: Mean indurations were 3.7 ± 3.9, 6.5 ± 5.4 and 9.2 ± 7.1 mm in children with no scar, one scar and two scars, respectively. No statistical difference was found between mean induration of children with one scar and those with two scars.

Conclusion: The effect of the number of BCG vaccinations and the time interval between vaccination and tuberculin skin test application on tuberculin skin test responses was statistically insignificant.
Influence of anthropometric parameters on the body composition measured by bioelectrical impedance analysis or DXA in children
Authors: Leppik A , Jürimäe T , Jürimäe J
Published: August 2010

Aim: To investigate the influence of anthropometric measures (skinfold thicknesses, girths, lengths and breadths/lengths) on (1) the whole body impedance and impedance index and (2) the body fat mass measured by means of DXA in children. Methods: Nine skinfolds, 13 girths, eight lengths and eight breadths/lengths were measured in 26 boys and 27 girls, 11–12 y of age. The somatotype components—endomorphy, mesomorphy and ectomorphy—were assessed according to the method of Carter and Heath. Body impedance at 50 kHz was measured (Multiscan 5000, Bodystat Ltd, UK) and impedance index (height2/impedance) was calculated. Four body components—total body fat mass and separate hands, legs and trunk fat mass—were determined using DXA. Results: Skinfold thicknesses did not influence body impedance or impedance index according to stepwise multiple regression analysis. Impedance index was influenced more by the girth measures than was body impedance. The leg length measures highly influenced the impedance index (50–81%, R2± 100). Different breadth/length parameters influenced body impedance and body impedance index (21–49%). Mesomorphy influenced body impedance only in boys (35%). Body fat mass measured by DXA was highly dependent on the measured skinfold thicknesses (59–92%). The influence of lengths and breadths/lengths on the total fat mass was significant (25–49%). Endomorphy characterized total fat mass as 86% and 52% in boys and girls, respectively.

Conclusion: Variation in anthropometry highly determined the variance observed in impedance in children, and the girths were the best predictors of impedance. Selected skinfold thicknesses highly predicted fat mass measured by DXA for total body, trunk, arms and legs.
Using radioligand‐binding assays to measure tissue transglutaminase autoantibodies in young children
Authors: Agardh D , Carlsson A , Lynch K , Axelsson I , Lernmark Å , Ivarsson S‐A
Published: August 2010

Aim: To measure autoantibodies against tissue transglutaminase (tTG) in young children prospectively screened for coeliac disease (CD). Methods: In total, 652 children aged 2.9 (2.5–4.2) y were analysed for IgA‐tTG and IgG‐tTG with radioligand‐binding assays and IgA endomysial antibodies (EMA) by indirect immunofluorescence. Antibody‐positive children were retested after 1.2 (range 0.2–1.9) y. Intestinal biopsy was performed on children with persistently high antibody levels. Results: In total, 3.2% (95% CI: 1.9–4.6%) of the 652 children were positive for at least one antibody at baseline: 2.5% (95% CI: 1.3–3.7%) for IgA‐tTG, 1.7% (95% CI: 0.7–2.7%) for IgG‐tTG and 2.9% (95% CI: 1.6–4.2%) for IgA‐EMA, respectively. Ten children were positive for all three antibodies, five for both IgA‐tTG and EMA, four for EMA only, one for IgA‐tTG and another for IgG‐tTG. IgA‐EMA titres correlated with IgA‐tTG levels (r= 0.73, p= 0.0003). At follow‐up, seven of 20 children remained positive for all three antibodies, three for IgA‐tTG only, one for both IgA‐tTG and EMA, one for IgA‐tTG and IgG‐tTG, and the remaining child refused further participation. Three biopsies showed villous atrophy, two increased intraepithelial lymphocytes and two normal findings. Biopsy was not performed in four children with low or declining tTG antibody levels at follow‐up and in one child who declined. CD was evident in 0.5% (95% CI: 0.0–1.0%) (3/652).

Conclusion: This study revealed a high number of young children positive for tTG antibodies as well as EMA, but the majority showed declining levels in both antibodies over time. We suggest using radioligand‐binding assays for quantitative measurement of tTG antibodies when change in antibody levels is studied in young children.
Relation of serum leptin and insulin‐like growth factor‐1 levels to intima‐media thickness and functions of common carotid artery in children and adolescents with type 1 diabetes
Authors: Atabek ME , Kurtoglu S , Demir F , Baykara M
Published: August 2010

Background and aim: Leptin and insulin‐like growth factor‐1 (IGF‐1) have been suggested to be involved in the pathogenesis of atherosclerosis. The aim of this study was to evaluate the relationship between serum leptin, IGF‐1 and intima‐media thickness (IMT) and functions of common carotid artery (CCA) in children and adolescent patients with type 1 diabetes. Material and methods: Serum leptin and IGF‐1 levels were measured in 45 diabetic patients (23 girls and 22 boys). Age, diabetes duration as well as major cardiovascular risk factors, including anthropometric and metabolic parameters, were matched between girls and boys. The relation of serum leptin and IGF‐1 levels to CCA structure and functions were measured by ultrasonography as IMT, cross‐sectional compliance (CSC), cross‐sectional distensibility (CSD), diastolic wall stress (DWS) and incremental elastic modulus (IEM). Results: Serum leptin levels of diabetic girls were higher than those in the boys (21.8 ± 14.5 μg/1 vs 8.9 ± 10.6 μ.g/1, p= 0.002). However, the difference for serum IGF‐1 levels was not significant between diabetic girls and boys (240.7 ± 96.8 μg/ml vs 234.7 ± 93.2 ng/ml; p < 0.05). In all subjects, leptin levels were correlated with CSC (p= 0.04), CSD (p= 0.04) and IEM (p= 0.01), and IGF‐I levels were only correlated with CSC (p= 0.01). Leptin did not show any correlation with ultrasonographic measurements in both girls and boys separately. IGF‐1 was correlated with CSC (p= 0.001), CSD (p= 0.002) and IEM (p > 0.001) in boys but not in girls. In a multivariate regression model, IGF‐1 emerged as independent correlates for mean CSD and IEM in boys but not in girls.

Conclusion: Serum leptin and IGF‐1 levels in children and adolescent patients with type 1 diabetes are associated with functions of common carotid artery, and the association of IGF‐1 levels is influenced by sex.
Effects of intralipid infusion on blood viscosity and other haemorheological parameters in neonates and children
Authors: Kessler U , Poeschl J , Raz D , Linderkamp O , Bauer J
Published: August 2010

Aim: To study acute haemorheological effects of intralipid in preterm and full‐term neonates and children. Circulatory complications of intralipid infusion, such as increases in pulmonary and peripheral flow resistance, have been associated with impaired blood rheology. Methods: During total parenteral nutrition, 10 preterm infants, 10 full‐term neonates and 10 children received an initial dose of intralipid as continuous infusion (0.6 g/kg) over 4 h. Additionally, blood of 10 healthy preterm infants, 10 full‐term neonates and 10 adults was incubated with intralipid. Whole blood and plasma viscosity (capillary viscometer), red blood cell (RBC) deformability (rheoscope) and RBC aggregation (Myrenne aggregometer) were measured before and after intralipid infusion and before and after in vitro incubation of blood with intralipid. Results: During intralipid infusion, plasma triglyceride levels increased from 0.13 ± 0.27 to 2.16 ± 0.68g/l in the preterm infants, from 0.14 ± 0.21 to 1.64 ± 0.54g/l in the full‐term neonates and from 0.65 ± 0.31 to 2.26 ± 0.60 g/l in the children. Whole blood viscosity decreased by about 10% after intralipid in all three groups due to similar decreases in haematocrit. RBC aggregation decreased by about 20% after intralipid infusion. Plasma proteins, plasma viscosity and RBC deformation were not affected by intralipid. In vitro incubation of blood with intralipid resulted in a marked reduction of RBC aggregation that was related to the intralipid concentration. At intralipid concentrations of 4 and 8 mg/ml, no RBC aggregation was noted in preterm and full‐term neonates. In adults, RBC aggregation decreased by 50%.

Conclusions: Previously described deleterious effects of intralipid on circulation can not be explained by changes in haemorheological properties.