bluuebunny/crossref_metadata_2025 huggingface dataset:
Self‐inflicted ocular mutilation in the pediatric age group
Authors: Ashkenazi Isaac , Shahar Eli , Brand Nathan , Bartov Elisha , Blumenthal Michael
Published: January 2008

Three mentally retarded children with severe self‐inflicted ocular injuries are presented. All three suffered from severe ocular injuries including retinal detachment resulting in progressive visual loss and even blindness. Self‐inflicted injuries to the eyes, including self enucleation, is an extremely uncommon form of behavior, rarely encountered by pediatricians. The risk of ocular morbidity is high if the diagnosis is overlooked. Technical advances in ophthalmology permit much improvement in some formerly hopeless cases of ocular self‐mutilation, but there is still no accurate method to repair destroyed retinal or nervous tissue. Early identification of patients at risk of ocular self‐mutilation is essential in order to prevent or minimize such severe ocular injuries.
Rapid decrease in tuberculin skin test reactivity at preschool age after newborn vaccination
Authors: Kröger L , Katila ML , Korppi M , Brander E , Pietikäinen M
Published: January 2008

A study of tuberculin sensitivity was performed in 353 children aged 4–6 years, all vaccinated at birth with British BCG vaccine. Significant waning of tuberculin reactions with increasing age was found (p < 0.05). In the age group < 4.5 years, the mean tuberculin reaction was 6.6 mm, in the age group 4.5–5.5 years 5.2 mm and in the age group of > 5.5 years 3.5 mm. The number of children with positive reactions ( 5 mm) was 165 (40%) and those with strong reactions ( 10 mm) 49 (14%). None of the latter children had active tuberculosis during a follow‐up period of 12 months. Eighty‐three (24%) of the children had no reaction. The children who had been revaccinated with the MPR vaccine against measles, rubella and parotitis (n= 31) had significantly larger tuberculin reactions than the non‐revaccinated children. Atopic dermatitis or infections during the preceding six months did not have any significant influence on reaction sizes. Our results demonstrate that the variation in size of tuberculin reactions after BCG vaccination at birth is large. We conclude that tuberculin sensitivity wanes rapidly by the age of 4.0–6.3 years.
Miliary tuberculosis with acute respiratory failure and histiocytic hemophagocytosis. Successful treatment with extracorporeal lung support and epipodophyllotoxin VP 16‐213
Authors: Monier B , Fauroux B , Chevalier JY , Leverger G , Nathanson M , Costil J , Tournier G
Published: January 2008

A 14‐year‐old girl with high fever, dyspnea and bilateral miliary nodules on chest X‐ray, developed a rapidly progressive respiratory failure associated with histiocytic hemophagocytosis. Histologic examination of bone marrow biopsy revealed tuberculous granulomas with caseating necrosis. We report a pediatric case in which treatment with extracorporeal lung support and epipodophyllotoxin VP 16‐213 was successful.
The care of fetal babies: survival of a 390‐g infant
Authors: Amato M
Published: January 2008

Infants with birth weight 750 g or less usually have a poor survival rate, and those who live have poor neurologic and intellectual outcome. With significant advances in perinatal care and meticulous neonatal support, the survival of these babies has improved in recent years and the long‐term outcome can be as good as that of larger low‐birth‐weight infants. It is likely that the reported increase in survival of ELBW infants reflects a changing obstetrical approach to the extremely premature fetus along with an increased attitude among pediatricians and neonatologists to treating such babies. This posture is motivated and supported by a number of factors, including regional systems of perinatal care that encourage early maternal transport to tertiary centers, an increasing ability of neonatal intensive care technology to achieve survival, and more optimistic long‐term neurodevelopmental outcome reports. Our experience is encouraging in this regard. This presentation reports the survival of an ELBW infant delivered in Switzerland before the completion of the 26th week of gestation and weighing 390 g at birth.
Deaths due to dysentery, acute and persistent diarrhoea among Brazilian infants
Authors: Victora Cesar G , Huttly Sharon R , Fuchs Sandra C , Nobre Leticia C , Barros Fernando C
Published: January 2008

In a population‐based study, all infant deaths occurring in a one‐year period in the metropolitan areas of Porto Alegre and Pelotas, in southern Brazil, were studied. There were 227 infants who presented diarrhoea during the fatal illness, and in 75% of these diarrhoea was considered to be the underlying cause of death. Acute diarrhoea (< 14 days’duration) accounted for 28% of the deaths, persistent diarrhoea for 62% and dysentery for a further 10%. Approximately one‐half of the children with persistent diarrhoea were admitted to a hospital in the first two weeks of the episode. Hospital‐acquired infections were likely to have contributed to one‐ to two‐thirds of deaths due to dysentery and persistent diarrhoea. A comparison with neighbourhood controls showed that breast milk provided substantial protection against deaths due to either acute or persistent diarrhoea.
Epidemiology of persistent diarrhea and etiologic agents in Mirzapur, Bangladesh
Authors: Henry Fitzroy J , Udoy Anwar Syeed , Wanke Christine A , Aziz KMA
Published: January 2008

To determine the epidemiology and etiologic agents of persistent diarrhea we carried out an intensive diarrhea surveillance on children less than six years old in rural Bangladesh. From March 1987 to February 1989 we examined 363 children through diarrhea recall interviews and analyzed stool samples of all diarrhea cases for potential pathogens. Results showed that children had an average of two episodes per year and the incidence rate of diarrheal episodes denned as acute (<14 d) and persistent (14 d) varied similarly with age. The peak incidence (episodes/child/year) of acute diarrhea (2.8) and persistent diarrhea (0.8) occurred in the 6‐11 months age group. The data showed that an episode tended to be prolonged if the stool was loose/mucoid or bloody at onset. Aggregative adherent Escherichia coli was found significantly more often at onset in persistent than in acute episodes, whereas Shigella, Aeromonas, Giardia and toxigenic E. coli were isolated with less frequency in persistent than acute episodes. This suggests that other factors might be more important in the development of persistent diarrhea than specific pathogens.
Association of indicators of hygiene behavior with persistent diarrhea of young children
Authors: Bartlett Alfred V , Hurtado Elena , Schroeder Dirk G , Mendez Humberto
Published: January 2008

We examined the association between water and hygiene‐related behaviors and persistent diarrhea (duration 14 days) among children under age three years in an indigenous rural Guatemalan community. Behavior indicators were specific aspects of the appearance of the mother, study child, other children and household that could be observed using a spot observation technique. Thirty‐four percent of children had one or more episodes of persistent diarrhea during the year of study. Bivariate analyses found that a higher proportion of observations in which the anti‐hygienic condition was observed was significantly associated with persistent diarrhea for 11 of 26 behavior indicators; these 11 indicators were also strongly correlated with each other. In individual logistic regression models, which included overall rate of diarrhea and other child characteristics associated with persistent diarrhea, six behavior indicators maintained significant association with persistent diarrhea: presence of toy on the ground, presence of baby bottle on the ground, the hands of the mother being dirty, presence of a fecally soiled diaper on the ground in the household compound, presence of feces in the yard, and the study child wearing a fecally soiled diaper. Three additional indicators closely approached significant association with persistent diarrhea. Excluding the three soiled diaper indicators, which might be the result rather than the cause of diarrhea, we found the six other behavior indicators to demonstrate a significant dose‐response effect in increasing risk of persistent diarrhea. These findings suggest that behaviors which promote increased exposure of young children to enteric pathogens increase risk of persistent diarrhea.
Effect of milk‐containing diets on the severity and duration of childhood diarrhea
Authors: Lembcke Jorge L , Brown Kenneth H
Published: January 2008

Individual components of milk from humans and other mammalian species may influence the severity, duration, and nutritional outcome of childhood diarrhea in different ways. Nonetheless, empirical data from clinical trials can be used to assess children's responses to specific milk‐containing diets. Factors modifying the response to milk include its source, amount, frequency of feeding, type of processing, and accompanying foods, as well as the type and severity of enteric infection and specific characteristics of the host. Whereas breast‐fed infants have less severe diarrhea when breast milk is continued rather than interrupted, infants and children fed with non‐human milks tend to have more severe illness than those receiving milk‐free or lactose‐limited formulas or milk‐cereal mixtures. Fermentation of milk may reduce the severity of lactose malabsorption, but additional information regarding the efficacy of yogurt in acute, childhood diarrhea is still needed.
Persistent diarrhoea: factors affecting absorption and clinical prognosis during management with a rice‐based diet
Authors: Roy SK , Akramuzzaman SM , Haider R , Majid N , Khatun M , Akbar MS , Alam AN
Published: January 2008

Twenty‐six persistent diarrhoea patients aged 4 to 18 months were treated with a diet prepared with rice powder, soya oil, glucose, egg white and water. Absorption of macronutrients was estimated in a 72 h balance study and clinical response was examined during one week of dietary treatment. Nutrient absorption was compared with that of 25 healthy age‐matched controls treated with the same diet. Twenty‐one patients (81%) recovered from diarrhoea within seven days. Absorption of nutrients was significantly reduced among the persistent diarrhoea patients. More malnourished patients had a significantly reduced absorption of nutrients except carbohydrate and an increased severity and longer duration of diarrhoea. Total gut transit time had significant association with nutrient absorption in the persistent diarrhoea patients. The period of recovery negatively correlated with coefficient of absorption and positively with initial stool weight. Failure to recover was associated with severity of diarrhoea and systemic infection. The study indicates that nutrient absorption is significantly reduced in patients with persistent diarrhoea and nutritional status, and that initial purging rate and intestinal hurry are significantly related to the prognosis and nutrient absorption.
Effects of partial plasma exchange transfusion on blood flow velocity in large arteries of arm and leg, and in cerebral arteries in polycythaemic newborn infants
Authors: Maertzdorf WJ , Tangelder GJ , Slaaf DW , Blanco CE
Published: January 2008

Continuous wave Doppler velocimetry was performed in brachial, femoral and cerebral arteries in four preterm, four small‐for‐gestational‐age (SGA) and eight appropriate‐for‐gestational age (AGA) polycythaemic newborns before and at 3 and 24 h after partial plasma exchange transfusion and in 18 matched controls at 3 and 24 h after birth. In peripheral arteries, end‐diastolic flow velocity was zero in all eight AGA controls, but only in two of the other infants. Consequently, mean flow velocity and red cell transport in AGA controls were significantly lower than in the other five groups, which did not differ. Partial plasma exchange transfusion did not influence flow velocities and red cell transport in peripheral arteries, but normalized the flow velocities in cerebral arteries in all three subgroups of polycythaemic infants, which were lower than in control infants. Cerebral red cell transport in controls increased significantly between 3 and 24 h, and in polycythaemic infants between 0 and 3 h after partial plasma exchange transfusion. In conclusion, reduction in haematocrit had different effects on blood flow velocity and red cell transport of peripheral and cerebral vessels, suggestirng that the increased cerebral blood flow velocity after partial plasma exchange transfusign is not simply due to a reduction in viscosity or oxygen content of the blood. The lower peripheral blood flow velocities in normocythaemic AGA infants as compared to all other groups, suggest that the level of maturity is an important determinant for the capacity to regulate blood flow.
Comparison of the effects of phenobarbitone and morphine administration on EEG activity in preterm babies
Authors: Bell Angela H , Greisen Gorm , Pryds Ole
Published: January 2008

Continuously recorded amplitude‐integrated EEG (aEEG) traces of 77 preterm babies were analysed retrospectively, to study the effect of different sedative drugs over a 24‐h period. Thirty‐seven babies were treated with phenobarbitone, 18 received morphine and 22 babies received no regular sedation. A “burstX” was defined as a discharge of integrated amplitude greater than 10 μV and maximum interburst intervals in 10‐min epochs over a 2‐h period were measured. Maximum interburst was prolonged in babies given either morphine or phenobarbitone for sedation. Administration of a single dose of diazepam for intubation had a marked additive effect on the EEG depression caused by the base sedative and prolonged the effect for 11 to 12 h after drug administration. We conclude that the effect of sedative drugs must therefore be accounted for when interpreting records of quantified EEG for 12 to 24 h after drug administration.
Infantile hydrocephalus in preterm, low‐birth‐weight infants—a nationwide Swedish cohort study 1979–1988
Authors: Fernell E , Hagberg G , Hagberg B
Published: January 2008

All Swedish infants with shunt‐treated infantile hydrocephalus, born during the period 1979–88 at 34 weeks gestational age and of low birth weight, were studied. Ninety‐six infants were born before 32 weeks and 50 at 32–34 weeks. The mean gestational age in the very preterm group gradually decreased from 29.5 to 27.3 weeks. The mean live birth prevalence was 15.9 per 1000 very preterm infants, and 5.1 per 1000 moderately preterm infants. No significant secular prevalence trends were found. The perinatal mortality decreased successively. The slowly decreasing trend in moderately preterm infants may imply better outcome in survivors. The slightly increasing trend in very preterm infants could be explained by more survivors in the low gestational age group. The aetiology was considered perinatal in 94% of the very preterm group and in 56% of the moderately preterm group; prenatal in 1% and 32% of infants, respectively. Additional neuropimairments were present in 82% of infants, cerebral palsy being the commonest (74%).
Clinical experience with a hypotonic oral rehydration solution in acute diarrhoea
Authors: Rautanen Tarja , El‐Radhi Sahib , Vesikari Timo
Published: January 2008

A hypotonic oral rehydration salts (ORS) solution with total osmolality of 224 rnosmol/l was compared in an open clinical trial with an isotonic (osmolality 304 mosmol/l) ORS solution for the treatment of dehydration due to acute diarrhoea. Both ORS solutions had the same electrolyte composition with a Na+ concentration of 60 mmol/l. Children given the hypotonic ORS solution (n= 103) passed significantly fewer diarrhoeal stools, and their diarrhoea and hospital stay were shorter than those of children given the isotonic ORS solution (n= 135). We conclude that hypotonic ORS (“light” ORS) has clinical advantages over the standard ORS currently used in Finland.
Rapid diagnosis of the cause of pneumoperitoneum in ventilated asthmatic children
Authors: Murdoch IA , Huggon IC
Published: January 2008

Two asthmatic children developed a pneumoperitoneum whilst being mechanically ventilated. A quick and accurate diagnosis as to the cause of the pneumoperitoneum was made by analysing the partial pressure of oxygen in the intraperitoneal free gas. This analysis helped to diagnose an intestinal perforation in one child and an air leak from lung barotrauma in the other. There was minimal delay in the surgical treatment of the child with intestinal perforation and in the other, an unnecessary laparotomy was avoided.
Pyomyositis and staphylococcal scalded skin syndrome
Authors: Wong GWK , Oppenheimer SJ , Evans RM , Leung SSF , Cheng JCY
Published: January 2008

Pyomyositis is a rare musculoskeletal infection in non‐tropical countries. We report a child who had pyomyositis complicated by staphylococcal scalded skin syndrome. This complication has not previously been described in patients with pyomyositis. Early diagnosis of pyomyositis was made by ultrasound examination, and percutaneous needle drainage under ultrasound guidance was performed. Pus aspirated and blood cultures grew Staphylococcus aureus. No open surgical drainage was required and resolution of the abscess was documented by serial ultrasound examinations.
“Covert toxocariasis” in a child treated with low‐dose diethylcarbamazine
Authors: Rasmussen LN , Dirdal M , Birkebaek NH
Published: January 2008

A girl aged 2.5 years with “covert toxocariasis” was treated with low‐dose diethylcarbamazine because of supposed noticeable disseminated Toxocara canis infection without ocular or visceral manifestations. There was marked blood and bone marrow eosinophilia, significant increased Toxocara canis antibody (ELISA) and immunoglobulins E, G and M, leucocytosis and an increased sedimentation rate. She had no geophagia, but often sucked small stones, probably contaminated with faeces from puppies. Symptoms were fever, inactivity, weakness, tiredness and loss of appetite. She was followed clinically and with blood samples throughout a period of three years and four months.
Progressive systemic sclerosis sine scleroderma in a child presenting as nocturnal seizures and Raynaud's phenomenon
Authors: Navon P , Halevi A , Brand A , Branski D , Rubinow A
Published: January 2008

Progressive systemic sclerosis sine scleroderma, as well as neurological manifestations of progressive systemic sclerosis are rare in adult‐onset cases. Neither have been reported in children with progressive systemic sclerosis, either separately or together. We describe a six‐year‐old girl with nocturnal seizures and Raynaud's phenomenon of three years' duration. She died of cardiopulmonary sclerosis without ever fitting the required criteria of systemic sclerosis. Nailfold capillaroscopy revealed the specific “scleroderma‐pattern” and provided the only clue for a diagnosis of progressive systemic sclerosis, confirmed eventually by skin biopsy.
Water‐balance hormones during long‐term follow‐up of oral dDAVP treatment in diabetes insipidus
Authors: Fjellestad‐Paulsen Anne , Laborde Kathleen , Kindermans Catherine , Czernichow Paul
Published: January 2008

The aim of the present study was to investigate the hormonal control of water‐balance in children with diabetes insipidus and to assess safety and efficacy of long‐term treatment with oral dDAVP. Plasma atrial natriuretic peptide, plasma renin activity, aldosterone, plasma and urinary cyclic 3'5′‐guanosine monophosphate and urinary prostaglandin Ez were measured in eight patients (aged 3–21 y) with central diabetes insipidus. At baseline, 12 h after the last dDAVP dose, patients had hypotonic polyuria but normal plasma sodium concentrations and plasma osmolality relative to a control group. The mean plasma atrial natriuretic peptide concentration in patients (26.2 ± 2.6 pg/ml) tended to be lower than in controls (36.5 ± 8.2 pg/ml. mean ± SEM), although the difference was not significant. Plasma cyclic 3′5′ guanosine monophosphate was higher in controls (6.0 ± 0.6 pmol/ml, mean ± SEM) than in patients (3.8 ± 0.3 pmol/ml). Aldosterone, plasma renin activity, urinary cyclic guanosine monophosphate and urinary prostaglandin E2 were similar in the two groups. During 3 h following dDAVP administration, atrial natriuretic peptide levels did not change in patients but decreased significantly in controls to 23.0 ± 4.0 pg/ml. No adverse reactions, or circulating antibodies against dDAVP, were observed after 3.5 years of oral dDAVP treatment. The average oral dDAVP dosage was similar after 1 and 3.5 years of treatment (906 ± 406μg/24 h, mean ± SD). Water‐balance is not detectably different from normal in correctly treated diabetes insipidus patients in terms of plasma atrial natriuretic peptide, plasma renin activity and aldosterone levels. Long‐term oral dDAVP treatment is safe and efficacious.
School achievement and school adaptation in children in relation to CNS development as assessed by a complex reaction time measured on school entry—a follow‐up
Authors: Frisk Max
Published: January 2008

Schoolchildren aged seven years underwent a complex reaction time (CRT) measurement and were followed up regarding language achievements and performance in gymnastics during the nine years of compulsory school. An analysis was made of the correlation between school results and CRT findings. In grade 3, there were large differences in psychomotor development between children with fast and slow CRT in both sexes. Only minor differences in school achievement were seen between girls in different CRT groups. Among the boys, however, many with a slow CRT were considered handicapped in language development, with dyslexia as the most important problem in addition to poor motoricity. They left compulsory school with poor results in Swedish, their native language, and gymnastics, and with a certificate that may reduce their chances of future studies and employment. The boys in general were inferior to the girls. The slow CRT boys, who were mainly considered to be developmentally delayed, also carried a risk of social maladjustment. It would appear to be important that psychophysical maturity receives attention at school, in addition to emotionatand social factors. The school health services have an important responsibility in this respect.
Exchange transfusion in neutropenic septicemic neonates: effect on granulocyte functions
Authors: Mathur NB , Subramanian BKM , Sharma VK , Puri RK
Published: January 2008

Depletion neutropenia caused by overwhelming bacterial infection is associated with fatal outcome and is an objective indicator of the severity of sepsis. Studies on controlled evaluation of exchange transfusion in the management of severe neonatal sepsis have not considered neutropenia as an inclusion critcrion, and randomized, controlled trials on evaluation of ncutrophil functions after exchange transfusion are scarce. This prompted us to carry out the present study. Septicemic neonates were enrolled if they had neutropenia and were randomized to undergo exchange transfusion (study group, n= 20) or not (controls, n=10). Granulocyte functions were assessed using the nitro blue tetrazolium (NBT) reduction test and the staphylococcicidal index. Blood was drawn for granulocyte function tests once from controls and donors, and before, immediately after and 6 h after exchange transfusion in the study group. Mortality was 35% in the study group and 70% in controls. Gram‐negative organisms accounted for 80%, in the study group and 90% in controls. Mean total leukocyte count and neutrophil count increased significantly immediately after exchange transfusion and 6 h later. Absolute band count decreased significantly immediately after exchange transfusion and incrcased 6 h later. NBT reduction in septicemic neonates in the study group, as wclras in controls. was significantly decreascd as compared to donor cells. NBT reduction improved significantly immediately after exchange transfusion and 6 h later. The valucs of the perccntage of viable staphylococci recovered from neutrophils also improved significantly immediately after exchange transfusion and 6 h later. We conclude that exchange transfusion with fresh whole blood in severe neonatal septicemia with neutropenia improves survival, increases the neutrophil count and cnhances neutrophil function.
Antigen and antibody assays in the aetiological diagnosis of respiratory infection in children
Authors: Korppi M , Heiskanen‐Kosma T , Leinonen M , Halonen P
Published: January 2008

The diagnostic efficacy of two methods—demonstration of seroconversion in paired sera and detection of antigen in clinical specimens—was evaluated in 183 children with respiratory syncytial, parain‐fluenza or adenoviral, or pneumococcal respiratory tract infection. Viral infection was diagnosed in 46 (37%) of the 125 cases by antigen assay alone, in 36 (29%) by antibody assay alone and in 43 (34%) by both methods. In respiratory syncytial viral infections, antigen assays were more often positive than antibody assays; 80% of the cases were antigen positive and 63% solely antigen positive. In parainfluenza and adenoviral infections, antigen assays were not as useful; a positive result was seen in 59% and 44% of cases, respectively. Pneumococcal infection was diagnosed in 25 (30%) of the 84 cases by antigen assay alone, in 54 (64%) by antibody assay alone and in only 5 (6%) by both methods. Thus nearly all pneumococcal infections were diagnosed by only one method. The efficacy of antigen and antibody assay was clearly dependent on the age of the patients. In infants less than six months of age, nearly all (27 (90%)) of the 30 infections were diagnosed by antigen detection; 25 solely by antigen detection. In older patients, antigen and antibody assays supplemented each other. We conclude that antigen detection should be used as the primary method for the diagnosis of viral or pneumococcal respiratory tract infection. In infants, antigen detection is the only reliable method of microbial diagnosis. In addition, antigen detection is the method of rapid microbial diagnosis. In pneumococcal infections, the sensitivities of antigen detection methods are not sufficient; this is an important area for further research.
Energy and nutrient intakes in congenital heart disease
Authors: Hansen S Rørnholt , Dörup I
Published: January 2008

Children with congenital heart disease may have significant growth retardation, which in part may be caused by insufficient dietary intake. Data on energy and nutrient intake were collected using a 14‐day dietary record by weighing, in 22 children with congenital heart disease (mean age 39 months, range 12–126 months), prior to corrective operation. When viewed in relation to actual weight, energy intake averaged 88% (SD 17%) of that recommended by the FAO/WHO/UNU. Energy intakes and weight SD scores were significantly correlated (r = 0.55, p < 0.01). Protein intake was generally high, and even sufficient to allow catch‐up growth. The majority of the children did not meet the recommendations for iron, zinc, calcium, or vitamins D, E, C, B1 or B6. Parents should be advised to give their children vitamin/mineral supplements, and to supply extra energy to children with failure to thrive.
Take of rhesus‐human reassortant tetravalent rotavirus vaccine in breast‐fed infants
Authors: Ceyhan Mehmet , Kanra Güler , Seçmeer Gülten , Midthun Karen , Davidson Bruce L , Zito Edward T , Vesikari Timo
Published: January 2008

Rhesus‐human reassortant tetravalent rotavirus vaccine at a titer of 4 x 104 plaque forming units was evaluated for immmunogenicity in 194 6–8‐week‐old breast‐fed Turkish infants. The vaccine was administered orally as a single dose following either a meal of breast milk or 30 ml of sodium bicarbonate‐buffered soy milk formula. Four‐fold or greater responses in rotavirus IgA ELISA antibody were detected in 62% and 65′% of the infants in the two groups, respectively (p= 0.62). In a smaller comparison group of non‐breast‐fed infants, an IgA response was detected in 7 of 11 (64%) cases. In all vaccinees, a serological response was detected in 72% of the initially seronegative and 47% of the initially seropositive infants (p= 0.001). We conclude that the take of rhesus‐human reassortant tetravalent rotavirus vaccine in breast‐fed infants is not compromised by breast feeding before vaccination. However, a higher titered preparation of the same vaccine may be required to improve overall immunogenicity in young infants, particularly in those with pre‐vaccination rotavirus antibody.
Immunological factors in milk from Brazilian mothers delivering small‐for‐date term neonates
Authors: Grumach AS , Carmona RC , Lazarotti D , Ribeiro MA , Rozentraub RB , Racz ML , Weinberg A , Carneiro‐Sampaio MMS
Published: January 2008

Breast milk samples from three groups of Brazilian women were evaluated: G1, mothers delivering term babies of low birth weight (n=16); G2, mothers delivering preterm babies of appropriate birth weight (n = 20); G3, mothers delivering term babies of appropriate birth weight (n = 30). Milk samples were obtained at 48 h and on the 7th, 15th, 30th and 60th days after delivery and they were analyzed for lysozyme and total IgA levels and for the presence of specific antibodies against Poliovirus types I, II, III, Rotavirus, Herpes simplex virus, Varicella zoster and Cytomegalovirus. The groups were not statistically different in relation to mother's age, parity, type of delivery or socio‐economic levels. IgA levels were higher in both low‐birth‐weight groups (G1 & G2) compared to the control group (G3) throughout the study period. Lysozyme levels decreased up to the 15th day, increasing thereafter up to the 60th day in all groups. Specific antibodies were detected throughout the study period, with no differences among groups. We conclude that breast milk composition of mothers delivering low‐birth‐weight babies (G1 & G2) was similar despite the different gestational ages.
Neurological manifestations of hemorrhagic colitis in the outbreak of Escherichia coli O157:H7 infection in Japan
Authors: Hamano Shin‐ichiro , Nakanishi Youko , Nara Takahiro , Seki Takashi , Ohtani Tomoko , Oishi Tsutomu , Joh Kosuke , Oikawa Tsuyoshi , Muramatsu Yasuo , Ogawa Yoshihiro , Akashi Shunji
Published: January 2008

An outbreak of hemorrhagic colitis associated with Escherichia coli O157:H7 occurred in a kindergarten in Saitama, Japan from September to November, 1990. Seven patients admitted to our hospital showed neurological manifestations: generalized seizures, impaired consciousness, urinary incontinence, gaze nystagmus, phrenic nerve palsy, action tremor and vertigo. Two patients died. On the basis of the clinical courses and laboratory findings of the seven patients and postmortem findings of one case, these neurological symptoms were suspected to be induced by the verotoxin elaborated by Escherichia coli O157:H7.
Transient erythroblastopenia of childhood presenting with echovirus 11 infection
Authors: Elian JC , Frappaz D , Pozzetto B , Freycon F
Published: January 2008

We report a case of transient erythroblastopenia in a three‐year‐old girl presenting with echovirus 11 infection. Viral infection was demonstrated by isolation of echovirus 11 in stool cultures and the presence of echovirus 11‐specific IgM antibody in serum. We suggest that echovirus may have played a role in the pathogenesis of transient erythroblastopenia of childhood in this patient.
Phosphate, alkaline phosphatase and bone mineralization in preterm neonates
Authors: Ryan SW , Truscott J , Simpson M , James J
Published: January 2008

We examined the relationship between bone mineralization, measured by single photon absorptio‐metry, and blood phosphate and alkaline phosphatase concentration in 71 preterm neonates. Although both alkaline phosphatase and phosphate concentrations were significantly related to bone mineral content, and alkaline phosphatase concentrations were related to bone mineral content relative to weight, each could only explain a small amount of the variation in bone mineralization. Hence, concentrations of neither could be used to identify those neonates with the greatest bone mineral deficits.
Decreased growth rate of low‐birth‐weight infants with prolonged maximum renal acid stimulation
Authors: Kalhoff H , Manz F , Diekmann L , Kunz C , Stock GJ , Weisser F
Published: January 2008

In a prospective randomized study, the urine pH of 170 premature and small‐for‐gestational‐age (SGA) newborns was routinely screened to detect patients with spontaneously developing maximum renal acid stimulation, an obligatory early stage in the development of late metabolic acidosis. Nitrogen assimilation was evaluated from the ratio of urinary nitrogen excretion and intake. Forty‐two premature infants and 10 SGA prematures and newborns after intensive care therapy with body weights greater than 1.5 kg and 25 prematures (including 7 SGA infants) with body weights less than 1.5 kg, spontaneously showed urine pH values below 5.4 on two consecutive days, suggesting maximum renal acid stimulation. These patients were randomly given either oral alkali therapy with sodium bicarbonate 2 mmol/kg/day or no therapy for a period of seven days. In both groups, urine pH was controlled daily. Patients in the control group without alkali therapy and with urine pH values less than 5.4 for seven days showed a significant decrease in weight gain and a tendency to decreased nitrogen assimilation. We assume that a regular check of urine pH in low‐birth‐weight infants is a useful non‐invasive method of detecting patients in the early stages of development of late metabolic acidosis, i.e. in the stage of “incipient late metabolic acidosis”. This would procide the possibility of starting early effective therapy and thereby reduce the mean duration of admission to neonatal wards. Regarding the risk of a high renal acid load causing the development of late metabolic acidosis in very low‐birth‐weight infants, standard formulas for premature infants should be re‐evaluated with the aim of reducing renal acid load leaving a larger renal surplus capacity for renal acid excretion.
The use of imipenem‐cilastatin in neonatal meningitis caused by Citrobacter diversus
Authors: Haimi‐Cohen Y , Amir J , Weinstock A , Varsano I
Published: January 2008

Citrobacter diversus is a cause of severe meningitis in neonates and infants. It is unique in its propensity to produce brain abscesses that play an important role in the poor prognosis associated with this condition. The recommended therapeutic regimen of third‐generation cephalosporines, aminoglyco‐sides and trimethoprim‐sulfamethoxazole is usually disappointing. We describe the use of imipenem‐cilastatin in successfully treating Citrobacter diversus meningitis complicated by brain abscesses.
Faecal short‐chain fatty acids in breast‐fed and bottle‐fed infants
Authors: Siigur U , Ormisson A , Tamm A
Published: January 2008

Faecal short‐chain fatty acids (SCFAs) were determined in 49 infants on three occasions, i.e. at ages three and six days and two months. At two months, the breast‐fed infants had a significantly higher proportion of acetic acid in the SCFA spectra than the bottle‐fed infants. The data suggest that the composition of the intestinal microflora in most breast‐fed infants is characterized by a high relative content of acetic acid in faecal SCFAs. This may be associated with protection against diarrhoea and respiratory infections in the infant.
The frequency of a disease‐causing point mutation in the gene coding for medium‐chain acyl‐CoA dehydrogenase in sudden infant death syndrome
Authors: Lundemose Jytte B , Gregersen Niels , Karlvraa Steen , Pedersen Bent Nerrgaard , Gregersen Markil , Helweg‐Larsen Karin , Simonsen Jarrn
Published: January 2008

A number of rare inherited metabolic disorders are known to lead to death in infancy. Deficiency of medium‐chain acyl CoA dehydrogenase has, on clinical grounds, been related particularly to sudden infant death syndrome. The contribution of this disorder to the etiology of sudden infant death syndrome is still a matter of controversy. The present study investigated 120 well‐defined cases of sudden infant death syndrome in order to detect the frequency of the most common disease‐causing point mutation in the gene coding for medium‐chain acyl‐CoA dehydrogenase (G985) compared with the frequency in the general population. A highly specific polymerase chain reaction assay was applied on dried blood spots. No over‐representation of homo‐ or heterozygosity‐for G985 appears to exist in such a strictly defined population, for which reason it may be m'bre relevant to look at a broader spectrum of clinical presentations of inherited metabolic disorders and examine a wider range of sudden death in infancy.
Adenovirus type 7h respiratory infections: a report of 29 cases of acute lower respiratory disease
Authors: Murtagh Patricia , Cerqueiro Cristina , Halac Alicia , Avila Maria , Kajon Adriana
Published: January 2008

Twenty‐nine cases of pediatric acute lower respiratory disease associated with adenovirus genome type 7h were evaluated retrospectively. They constituted 2.4% of 1233 cases of acute respiratory infections treated in five hospitals in Buenos Aires, between September 1984 and September 1988. Pneumonia and bronchiolitis were the principal diagnoses. The mean age of patients was 8.8 months and 82.7% of the children were less than one year of age. None of the patients had previously been exposed to measles or was immunocompromised. A mixed infection, viral or bacterial, was demonstrated in 8 of the 29 patients. Sixteen children developed a severe pulmonary disease which required intensive care. Ten with a clinical diagnosis of multifocal pneumonia and necrotizing bronchiolitis died. Extrapulmonary manifestations were observed in the most severe cases. Observations suggest a possible high pathogenicity of adenovirus type 7h and emphasize the need for adequate control and case management programs.
Hypertrophic obstructive cardiomyopathy as a side effect of dexamethasone treatment for bronchopulmonary dysplasia
Authors: Brand Paul LP , A van Lingen Richard , Brus Frank , Talsma Melle D , Elzenga Nynke J
Published: January 2008

We report three infants who developed hypertrophic obstructive cardiomyopathy during dexamethasone treatment for bronchopulmonary dysplasia. In all three infants, echocardiography had ruled out cardiac abnormalities prior to the dexamethasone course. The hypertrophic obstructive cardiomyopathy appeared and progressed during dexamethasone therapy and resolved completely after its cessation. This suggests a causative association between the hypertrophic obstructive cardiomyopathy and the exogenous glucocorticosteroid therapy. The mechanism of this dexamethasone‐related hypertrophic obstructive cardiomyopathy is unclear. This complication may be encountered more frequently with the increasing use of dexamethasone in infants with bronchopulmonary dysplasia.
Type of milk feeding in infants and young children up to 19 months of age in three Socio‐economic groups in Madrid
Authors: Van Den Boom SAM , Kimber AC , Morgan JB
Published: January 2008

The feeding practices of 344 children in Madrid between 3 and 19 months were investigated by controlled interview or their mothers of care‐takers. Four different types of milk were given to the children: human milk, infant formula, follow‐on formula and cow's milk. Three periods could be defined when infants were most likely to change from one milk type to another. The majority of babies changed from human milk to infant formula some time in the first three months of life. At between four and six months, about half the sample changed to a follow‐on formula and, finally, around the baby's first year formula was substituted for cow's milk. Differences in feeding behaviour could be observed among Socio‐economic groups, but were not statistically significant. Feeding patterns closely followed international recommendations for infant feeding.
Typical technetium dimercaptosuccinic acid distribution patterns in acute pyelonephritis
Authors: Wallin L , Bajc M
Published: January 2008

Technetium dimercaptosuccinic acid renal scintiscans in 37 children with clinical diagnosis of acute pyelonephritis were reviewed. In 18 children, follow‐up scintigraphy was obtained after an interval ranging from 5 to 8 months. Uptake abnormalities were found in 89% of the children (74% of the kidneys). We were able to identify four typical pathological uptake patterns: (i) pole defect(s), usually wedge shaped (60%); (ii) lateral wedge shaped defect (4%); (ii) scattered multiple defects (21Yo); and (iv) swollen kidney without areas of diminished uptake (15%). Remaining pathology at follow‐up was found in 52% of the kidneys. Vesicoureteric reflux was present in 33% of the children with scintigraphic signs of pyelonephritis. Frequencies of parenchymal changes in the acute phase and at follow‐up were not significantly correlated to the presence of reflux.
Systemic activity of inhaled topical steroid in toddlers studied by knemometry
Authors: Bisgaard Hans
Published: January 2008

The short‐term linear growth rate of the lower leg in toddlers was measured and evaluated in order to study the possible effect of inhaled budesonide on this factor in toddlers with mild recurrent wheezing. The short‐term linear growth rate of the lower leg was measured weekly using a hand‐held knemonieter. Eighteen toddlers aged 13–36 months (mean 27 months) with a history of recurrent wheezing requiring inhaled topical steroids, but without need of regular medication during the months prior to the study, were studied. The children were randomized blindly through three consecutive treatment periods of four weeks with placebo or budesonide in daily doses of 200 μg and 800 μg administered as a pressurized aerosol inhaled via a spacer with a face mask. Twenty‐nine percent (median) of the nominal dose was delivered at the mouth of the children. Three children were withdrawn because of exacerbations and one because of non‐compliance. The precision of the measurement procedure was 51 μm/day. The mean growth rate during placebo, low‐dose and high‐dose steroid treatment was 92 μm/day, 114 μm/day and 46 μm/day respectively. The growth rate during the high‐dose treatment was suppressed significantly compared to placebo treatment (95% CI ‐ 76 μm/day to ‐17 μm/day), whereas the growth rate during low‐dose steroid treatment was indistinguishable from placebo treatment (95% CI —7 to +52 μm/day). In conclusion, measurement of short‐term linear growth rate by knemometry in toddlers is a fast and gentle niethod with a high level of precision. The measurements may reflect systemic activity of steyoicttreatment, but probably do not indicate long‐term changes in statural height. Inhalation of a daily nominal dose of 200 μg of budesonide did not affect short‐term growth, but an 800 μg daily dose caused a slower short‐term growth. This study corroborates the safety of treating toddlers with budesonide 200 μg inhaled from a spacer device, and indicates the importance of minimizing the dose.
Intra‐articular glucocorticoids in early juvenile chronic arthritis
Authors: Honkanen VEA , Rautonen JK , Pelkonen PM
Published: January 2008

The efficacy of intra‐articular glucocorticoid injections in the early phase of knee joint synovitis was studied in 79 children with juvenile chronic arthritis (42 girls and 37 boys). Half of the injections were given within the first six months from the onset of the disease. The probability of a patient staying in remission was much higher in triamcinolone‐treated patients than in patients receiving methylprcdni‐solone (p<0.0005, Breslow statistics). Using multivariate analysis there was a significant association between the length of remission and the synovial fluid polymorphonuclcar leucocyte proportion (SF‐PMN%. Patients with a high SF‐PMN% tended to have shorter remissions than those with a low SF‐PMN% (improvement of the fit in stcpwise model: chi‐square = 8.81,p<0.005). The difference between triamcinolone and methylprednisolone groups was still clearly evident two years after injection.
Early child health in Lahore, Pakistan: V. Feeding patterns
Authors: Ashraf RN , Jalil F , Khan SR , Zaman S , Karlberg J , Lindblad BS , Hanson LÅ
Published: January 2008

The feeding practices of children (n=1476) from birth to 24 months, as determined in a longitudinal study, in Lahore, Pakistan, are presented. Four socioeconomic groups at various levels of urbanization were included; a village, periurban slum, urban slum and an upper middle class. Initiation of breastfeeding was delayed in all the neonates. Sixty‐five percent of the periurban slum mothers and 45% of the village mothers had not started breastfeeding at 48 hours after the birth of the infant. Prelacteal feedings, especially of herb water and honey, were the norm. Breastfeeding was highly prevalent. Eighty‐seven to 98% of the infants in all the areas were breastfed at one month of age. Exclusive breastfeeding was rare, with 9% at one month, declining rapidly with age and being highly influenced by season. Partial breastfeeding was the most common mode of feeding. Water in addition to human milk was given by 45–73 % of the mothers living in the urban slum, village and periurban slum at one month of age. Fresh animal milk and/or commercial formula was already being given at 1 month by 22–64% of the mothers in all areas. Commercial formula was the preferred food in the upper middle class, while in the other three areas it was rare and fresh animal milk was mainly used. More than 50% of the mothers in the village and in the periurban slum gave diluted animal milk even beyond the age of 10–15 months. In the upper middle class 50% of the infants were fed semisolids at the age of four months, while in the village, the periurban and the urban slum at 6 months of age only lo%, 12% and 47% of the infants received semisolids. The results of this study indicate that breastfeeding was highly prevalent in the three poorest areas. However, in all the areas initiation of breastfeeding was delayed and prelacteal feeding was the norm. Exclusive breastfeeding was rare, feeding bottles were used by 82–100% of the mothers to feed supplements and human milk substitutes, in the four areas.
Early child health in Lahore, Pakistan: VII. Diarrhoea
Authors: Mahmud A , Jalil F , Karlberg J , Lindblad BS
Published: January 2008

Mahmud A, Jalil F, Karlberg J, Lindblad BS. Early child health in Lahore, Pakistan: VII. Diarrhoea. Acta Paediatr 1993;390(suppl):79–85. Stockholm. ISSN 0803–5326

This study was carried out to obtain reliable prospective data on the incidence, home management and duration of infantile diarrhoeal disease in a developing and rapidly urbanizing community. Fourteen hundred and seventy six infants from 4 different communities of Lahore, representing different stages of urbanization, were followed prospectively from birth to 2 years of age. Each child had an average of 3.6 episodes of diarrhoea during one year; 4.3 episodes per child per year in the village, 4.4 in the periurban slum, 3.4 in the urban slum and 1.4 in the upper middle (Um) class control group. The maximum incidence of diarrhoeal episodes occurred in children between 9–10 months of age. No sex difference was found. The seasonal variation showed a peak incidence during April‐June. Bloody diarrhoea, in 3–5% of the episodes, was predominantly seen in winter months and in older infants. The maximum use of ORS was seen in the Um class (53%). Antibiotics were used in 75% of all diarrhoeal episodes maximally in the Um class, and morphine derivatives in 1% of all cases. The overall incidence of persistent diarrhoea was 14% of all acute cases, being highest in the village (18%), followed by the periurban slum (14%), Um class (10%) and urban slum (8%) with peak incidence occurring in June and July. Our results confirm the magnitude of the problem of diarrhoea. The proper selection of cohorts, the closely controlled prospective and simultaneous follow‐up study of these large samples representing different urbanization stages and socio‐economic conditions and the new detailed data on the duration of diarrhoeal episodes makes these results of wider international interest in addition to its importance for health planning in Pakistan.