bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic treatment of children with vesico‐ureteric reflux
Authors: Läckgren G , Wåhlin N , Stenberg A
Published: August 2010

Endoscopic subureteric injection of tissue‐augmenting substances has become an alternative to long‐term antibiotic prophylaxis and open surgery in the treatment of children with vesico‐ureteric reflux. Successful elimination of reflux in about 80% of patients after a single injection (and in 90% after a repeat) has been achieved using the foreign‐body non‐degradable substances Teflon and silicone. Few patients have required open surgery and recurrence of reflux after initial successful treatment has occurred in only 5‐10%. Concern has arisen, however, about possible distant migration and granuloma formation after injection of particulate plastic materials. Cross‐linked bovine collagen is a biodegradable alternative substance, but with a lower response rate of 60% after the first treatment and a recurrence rate of 10‐20%. Dextranomer in sodium hyaluronan is a new biological substance with microparticles with a response rate of 69% after the first injection. Biological substances have caused few complications. Present literature on injection treatment unfortunately focuses on elimination of reflux, with little attention to subsequent frequency of pyelonephritis or to the long‐term development of the kidneys. Furthermore, there are no controlled, randomized studies with subureteric injection as one of the treatment alternatives. Thus, although having the advantage of being a minimally invasive procedure that can be performed on an outpatient basis, this technique needs to be tested in a large prospective study with the long‐term renal outcome as the main end‐point.
Psychological reaction by children of various ages to hospital care and invasive procedures
Authors: Hägglöf B
Published: August 2010

Hospital care and treatment by invasive procedures produce significant psychological effects on children. Urogenital surgery deserves particular study. The developmental aspects of different ages are highly relevant. A proposed multidimensional model of contributing factors includes type of medical treatment, any previous surgery, the child's temperament, coping strategies of both child and parents and their psychological health, support from parents and staff, information and psychological preparation and age of the child. Up to now, there have been no clear recommendations as to the best age for elective surgical procedures in children according to psychological risk. In general, older children adapt better psychologically after hospital care. The literature, however, tends to advise elective surgery before 12 mo of age, based on apparent psychological adjustment in the very young after surgery and from a desire to shorten the period of living with the malformation/disorder. However, increased follow‐up surgery from early interventions gives a higher risk of psychological problems. More well‐controlled studies are needed before final evaluation of the impact of surgical interventions on psycho‐social symptoms according to age group. In this analysis a multidimensional model is preferred.
Evolving experience in the management of empyema thoracis
Authors: Shankar KR , Kenny SE , Okoye BO , Carty ML , Lloyd DA , Losty PD
Published: August 2010

The optimal management of paediatric empyema thoracis remains controversial. The objective of the study was to analyse evolving experience in clinical presentation, management, outcome and factors contributing to adverse morbidity in thoracic empyema. Forty‐seven patients presenting to a paediatric surgical centre were studied in three consecutive 6‐y periods during 1980‐97 to compare any change in the pattern of disease influencing diagnosis and management. Patients were categorized into two treatment groups: (i) conservative management (antibiotics and/or tube thoracostomy), (ii) thoracotomy. The median duration of illness prior to hospital admission was 10 d (range 1‐42 d). Ultrasound was increasingly utilized in the diagnosis and staging of empyema and played an important role in directing definitive management. The presence of loculated pleural fluid determined the need for thoracotomy. Sixteen of 20 patients (80%) who were initially treated with thoracocentesis or tube thoracostomy eventually needed thoracotomy. There was a positive shift in management towards early thoracotomy resulting in prompt symptomatic recovery. Significant complications were noted in seven children who had delayed thoracotomy. These included recurrent empyema with lung abscess (n= 2), scoliosis (n= 2), restrictive lung disease (n= 1), bronchopleural fistula (n= 1) and sympathetic pericardial effusion (n= 1). An unfavourable experience with delayed thoracotomy during the study period has led us to adopt a more aggressive early operative approach to empyema thoracis. The decision to undertake thoracotomy has been influenced by the ultrasound findings of organized loculated pleural fluid. Delayed surgery was associated with adverse outcome.

Whilst fibrinolytics and thoracoscopy may provide attractive options for early empyema, thoracotomy can hasten patient recovery regardless of the stage of disease. Prospective randomized trials are required to assess the ideal therapy for childhood empyema.
Changes in prevalence and severity of asthma among schoolchildren in a Swedish district between 1985 and 1995
Authors: Bråbäck L , Appelberg J , Jansson U , Kälvesten L
Published: August 2010

The same questionnaire and study design was used in two surveys of asthma among all the children attending the 9‐y compulsory school in Sundsvall in 1985 (n= 10527) and 1995 (n = 9165). A detailed questionnaire was distributed by post to the parents of all children who had answered in the affirmative to a simple screening question on asthmatic symptoms at the beginning of the autumn term. The questionnaire contained detailed questions on symptoms and asthma management. Our findings indicated a moderate increase in reported asthma‐like symptoms and physician‐diagnosed asthma between 1985 and 1995. The severity of symptoms was unchanged, despite a large community‐based asthma campaign and a tenfold increase in the number of children receiving inhaled steroids. A validation analysis included an interview by a physician, a skin prick test, determination of specific IgE antibodies and spirometry. The oral interviews suggested that undertreatment was common. Many children had adequate medication at home, but this medication was not used properly. Finally, all 13‐14‐y‐old children also replied to written and video questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC). It is likely that differences in study design explained the much higher prevalence of wheezing in this part of the study.
Development of atopic sensitization and allergic diseases in early childhood
Authors: Vasar M , Julge K , Björkstén B
Published: August 2010

Atopic diseases and atopic sensitization were studied from birth up to 2 y in a population‐based prospective study. Physical examinations were done at 6, 12 and 24 mo, including skin‐prick tests and blood samples, for the determination of serum IgE level and circulating IgE antibodies to food and inhalant allergens. In addition, questionnaire surveys were done about clinical symptoms of allergy, infections and the home environment. At 2 y the prevalences of definite and probable atopic diseases were 17% and 13%, respectively. The cumulative incidence of allergy was 25%. Atopic dermatitis was the main manifestation of atopy, with a peak prevalence of 15% at 2 y. The prevalence of positive skin‐prick tests was constant at all ages, i.e. 7% at 6, 12 and 24 mo. Positive skin‐prick tests against inhaled allergens were more than twice as common at 24 than at 12 mo, while sensitivity to food decreased. In contrast, circulating IgE antibodies to egg became more common with age, reaching 20% at 2 y.

Conclusions: The present study indicates that manifestations of allergic diseases and incidence of sensitization to foods and inhalants are equally common in Estonian and Scandinavian children during the first 2 y of life, despite a much lower prevalence among older children and adults in Estonia.
Growth and neurodevelopmental outcome of very low birthweight infants with necrotizing enterocolitis
Authors: Sonntag J , Grimmer I , Scholz T , Metze B , Wit J , Obladen M
Published: August 2010

The aim of the study was to assess the effect of necrotizing enterocolitis (NEC) on neurodevelopmental outcome and growth. Neurodevelopmental outcome of 20 out of 22 suriviving very low birthweight infants (VLBW) diagnosed with NEC between 1992 and 1996 was compared with 40 control infants matched for gestational age and year of admission. Follow‐up studies were performed at 12 and 20 mo of corrected age. The German revision of the Griffiths' scales was used for development assessment. Neurodevelopment was significantly delayed in infants with NEC at 12 mo (median general developmental quotient: 90.0 vs 97.8; p = 0.04) and 20 mo (86.4 vs 97.7; p = 0.004) of age. Somatic growth did not differ between infants with and without NEC. Fifty‐five percent of infants suffering from NEC but only 22.5% of the infants without NEC were severely retarded (developmental quotient < ‐2 SD of a control group of healthy newborns) at 20 mo of corrected age.

Conclusion: Preterm infants developing NEC are at risk for neurodevelopmental impairment and need close neurodevelopmental follow‐up for the first years of life.
Evaluation of Protein S‐100 serum concentrations in healthy newborns and seven newborns with perinatal acidosis
Authors: Maschmann J , Erb MA , Heinemann MK , Ziemer G , Speer CP
Published: August 2010

We measured Protein S‐100 serum levels in 66 healthy newborns during the first week of life and in 7 newborns with perinatal acidosis. Normal values (n= 66) constantly ranged between 0.66 and 3.33 ug/1 (2.5 and 97.5 percentiles) during the evaluation period.

Conclusions: Newborns with signs of hypoxic‐ischaemic encephalopathy (HIE) after perinatal acidosis showed elevated Protein S‐100 serum levels, whereas newborns without these signs had normal concentrations. S‐100 might thus be a marker of central nervous system damage in newborns.
False alarms in very low birthweight infants: comparison between three intensive care monitoring systems
Authors: Ahlborn V , Bohnhorst B , Peter CS , Poets CF
Published: August 2010

Monitor alarms are a major burden on both patients and staff in intensive care units. We compared alarm rates from three different monitor systems (Hewlett Packard (HP), Kontron Instruments (KI), Marquette‐Hellige (MH)) in a tertiary neonatal intensive care unit. Monitors were used in random order on three consecutive days over 8h each in 16 preterm infants (median gestational age at birth 29 wk (range 24‐34), age at study 18 d (8‐53), weight at study 1160g (595‐1430)). Alarms were classified as true or false using flow sheets based on continuous observation of both the patient and related parameters. There was one alarm every 9 min of monitoring. The median number of true alarms did not differ significantly between systems, being 28 per 8 h (range 9‐87) for HP, 26 (3‐81) for KI, and 30 (5‐135) for MH. The median number of false alarms differed widely, with the HP system generating 32 (7‐77) such alarms per 8 h, compared to 8 (0‐19) for KI and 15 (2‐32) for MH (p < 0.01 HP vs KI and MH, p lt; 0.05 KI vs MH). These differences between systems were mainly due to differences in pulse oximeter and transcutaneous PO2 monitor alarm rates.

Conclusions: In conclusion, this study shows marked differences between both parameters and manufacturers in the frequency with which false alarms occur. It may provide a basis from which reductions in alarm rates can be sought.
Population‐based body mass index reference values from Göteborg, Sweden: birth to 18 years of age
Authors: He Q , Albertsson‐Wikland K , Karlberg J
Published: August 2010

The body mass index or BMI (weight/height2) is a somewhat crude estimate of nutritional status. However, due to its simplicity and high correlation with total body fat, it has been the method of choice in both paediatric clinics and research over the years. Since BMI is not an equivalent measure of the percentage of body fat in different ethnic groups and in the two sexes, population‐specific BMI reference data is needed. Several BMI reference values have been published for French, American, British and Hong Kong children in recent years. In Sweden, weight‐for‐age and height‐for‐age reference values, which were published in 1976, are still used as the current national growth reference values. Updated growth reference values are needed for assessing nutritional status due to the secular trend toward and increasing prevalence of childhood obesity. The aim of this study was to produce BMI reference values for Swedish children of paediatric age. The series came from a large Swedish population‐based longitudinal growth study of 3650 full‐term babies followed from birth to 18 y of age. The children in this data set were born in the early 1970s. The pattern and level of 50th centile BMI values presented here are quite similar to those of the Swedish cohort study in the 1950s. In comparison with the US BMI reference values, the Swedish values are much lower, especially for the higher centile values.

Conclusion:The new Swedish BMI chart from our study may provide a useful tool for paediatricians to assess body fat, and consequently nutritional status, in Swedish children.
Can parents predict the severity of childhood obstructive sleep apnoea?
Authors: Preutthipan A , Chantarojanasiri T , Suwanjutha S , Udomsubpayakul U
Published: August 2010

Objective: To determine whether parents' observations can be used to predict the severity of the obstructive sleep apnoea syndrome (OSAS) in children. Study design: Sixty‐five children with OSAS diagnosed by overnight polysomnography were consecutively recruited and classified as having severe or non‐severe OSAS according to the obstructive apnoea index (OAI) and the oxygen saturation measured by pulse oximetry (SpO2) nadir. Parents were asked to complete a questionnaire about the child's breathing difficulties at night. Results: Twenty‐eight patients were classified as severe OSAS and 37 as non‐severe OSAS. There were no differences between the two groups with respect to age, sex or body mass index. Male to female ratio was 5:1. Parents of children with severe OSAS more frequently reported observed cyanosis (35 vs 8%; p= 0.02); obstructive apnoea (60 vs 35%; p = 0.04); snoring extremely loudly (52 vs 22%; p = 0.01); shaking the child (64 vs 35%; p = 0.02); watching the child during sleep and being afraid of apnoea (85 vs 60%; p = 0.03). However, neither any single nor combinations of observations showed high values for both sensitivity and specificity.

Conclusions: Although some parents' observations are more frequently reported in children with severe OSAS, neither any single nor combinations of observations accurately predict the severity of OSAS. Polysomnography is still needed to determine the severity of obstruction.
Investigation and outcome of neonatal hepatitis in infants with hypopituitarism
Authors: Spray CH , McKiernan P , Waldron KE , Shaw N , Kirk J , Kelly DA
Published: August 2010

Congenital hypopituitarism is a recognized cause of neonatal hepatitis, but the diagnosis may be difficult to establish even if clinically suspected. In order to determine the natural history of this disorder, the outcome of 12 infants with neonatal hepatitis secondary to hypopituitarism is reviewed. The clinical diagnosis of hypopituitarism was established on a combination of features, which include dysmorphism (4 infants), optic nerve hypoplasia (8 infants), micropenis (5 male infants) and recurrent hypoglycaemia (blood glucose < 2.4 mmol/l (8 infants)). Endocrine investigation revealed low free thyroxine (T4) levels (<10 pmol/l), with normal thyroid stimulating hormone (TSH) levels (0.4‐4.5 mU/l) (11 infants), and serum cortisol levels which were inappropriately low (< 200 nmol/l). In 9 of 12 infants, liver disease resolved within 6 wk following treatment with thyroxine, hydrocortisone and, where appropriate, growth hormone, including Cases 9 and 1 in whom diagnosis and treatment were delayed until 3 mo and 3 y of age, respectively. Liver disease resolved spontaneously in two infants prior to starting hormone replacement therapy (Cases 11, 12), and one male infant (Case 10), in whom the diagnosis and hormone replacement therapy were delayed until 5 y of age, developed cirrhosis and portal hypertension and later underwent liver transplantation.

Conclusion: The diagnosis of hypopituitarism should always be considered in infants with unexplained neonatal hepatitis. Delay in diagnosis and appropriate treatment was associated with persistently abnormal liver function tests and may lead to irreversible liver disease.
Thymus size and its relationship to perinatal events
Authors: Chen C‐M , Yu K‐Y , Lin H‐C , Yeh G‐C , Hsu H‐H
Published: August 2010

A retrospective study was conducted to assess radiographically the thymus size in well and sick neonates and to search for a possible relationship to perinatal events. Thymus size was expressed as cardiothymic:thoracic ratio (CT/T) by measuring the width of the cardiothymic shadow at the level of carina and dividing it by the width of the thorax at the costophrenic angles. The CT/T was measured on chest radiographs obtained on day 1 in well term neonates consecutively born in our nursery and sick neonates with meconium staining of the amniotic fluid, meconium aspiration syndrome or respiratory distress syndrome (RDS). Neonates with congenital anomalies, congenital heart disease or intrauterine growth retardation were excluded. There were no significant relationships between CT/T and sex, birth route, birthweight or gestational age in well and sick term neonates. The CT/T were comparable among well and sick term neonates and were significantly greater in the preterm neonates with RDS than in the preterm neonates without RDS. The CT/T was correlated to the birth route only in the preterm neonates.

We conclude that thymus involution in the perinatal period is a complex process and the response is different between term and preterm neonates.
Effects of back care education in elementary schoolchildren
Authors: Cardon G , De Clercq D , De Bourdeaudhuij I
Published: August 2010

The purpose of this study was to investigate the effects of a back care education programme, consisting of six sessions of 1 h each, in fourth‐ and fifth‐grade elementary schoolchildren. Testing consisted of a practical performance and a back care knowledge test. Forty‐two subjects and 36 controls performed a pre‐test and were tested within 1 wk after the programme. To monitor effects and follow‐up effects on a larger sample, 82 different pupils were tested within 1 wk after the programme and 116 other children 3 mo after. Both larger samples were compared with one group of 129 controls. Interrater reliability for the test items of the practical assessment was high; intraclass correlation coefficients varied from 0.785 to 0.980. In the pre/post design study, interaction between time and condition was significant for the sum score of the practical assessment and for the knowledge test (p < 0.001), with higher scores for the intervention group (15% improvement for the knowledge test score, 31.6% for the practical sum score). Significantly higher sum scores for the knowledge test and for all practical assessment items were found in the intervention groups, tested within 1 wk and 3 mo after the programme, in comparison with the control group (p <0.001).

Conclusion: The effectiveness of a primary educational prevention programme on back care principles was demonstrated in this study. Effectiveness, long‐term outcomes and behavioural changes need further evaluation to optimize back care prevention programmes for elementary schoolchildren.
Lupus anticoagulant and protein S deficiency in otherwise healthy children with acute varicella infection
Authors: Kurugöl Z , Vardar F , Özkinay F , Kavakh K , Özkinay C
Published: August 2010

Acquired protein S deficiency and lupus anticoagulant have been described in children with varicella who had purpura fulminans, disseminated intravascular coagulation or thrombosis. The aim of this study was to investigate the natural anticoagulants, hypercoagulability markers, other parameters of coagulation and fibrinolytic systems, and the presence of the lupus anticoagulant in otherwise healthy children with acute varicella infection. Blood samples were obtained from 17 children with varicella without thrombosis during acute varicella infection and 1 mo after onset. Coagulation tests included determinations of the prothrombin time, the activated partial thromboplastin time, the thrombin time, the thrombin antithrombin complex, the prothrombin fragment F 1 + 2, the tissue plasminogen activator, the plasminogen activator inhibitor‐1, protein C activity and free protein S antigen. Antiphospholipid antibodies were determined in enzyme‐linked immunosorbent assays. The mean free protein S concentration in the acute phase (0.63 ±0.16U/ml) was significantly lower than that of the concentration determined 1 mo later (0.82 ± 0.17 U/ml). The children with acquired free protein S deficiency also had a lupus anticoagulant. Elevated concentrations of the prothrombin fragment F 1+2, the thrombin antithrombin complex, D‐Dimer, tissue plasminogen activator and plasminogen activator inhibitor‐1 were detected in most of the children.

Conclusion: There is a significantly increased prevalence of lupus anticoagulant, a significantly reduced plasma concentration of free protein S and elevations in coagulation and fibrinolytic parameters in otherwise healthy children with acute varicella infection.
Non‐nutritive sucking by infants exposed to pethidine in utero
Authors: Hafström M , Kjellmer I
Published: August 2010

Obstetric analgesia in the form of pethidine (meperidine) to mothers during delivery has adverse effects on some aspects of the behaviour of their newborn infants. The non‐nutritive sucking (NNS) pattern of nine healthy full‐term infants exposed to pethidine in utero was compared to that of a control group of infants. The pattern was analysed and quantified using an automatic computer‐based method. The results are discussed in the context of endogenous and exogenous opiates and their effect on brain‐stem rhythm generators.

Conclusions: The typical NNS pattern with alternating sucking activity (bursts) and pauses is preserved in the exposed infants. There is a significantly lower sucking frequency (md 1.74 vs 1.90 Hz, p= 0.030*) and a tendency to a less stable rhythm in pethidine‐exposed infants.
Childhood injuries in the European Union: Can epidemiology contribute to their control?
Authors: Petridou E
Published: August 2010

An average of 6000 children (0–14‐y‐old) died every year from injuries in the European Union during the last decade. Although the trends are overall favorable, injuries continue to represent the leading cause of death in this age group. The aim of this paper is to present childhood‐injury‐related public health issues and consider possible remedies of contemporary epidemiologic methods as applied to injury epidemiology and prevention. It has been estimated that half of the lives lost to childhood injuries could have been saved if all European Union countries matched the accomplishments of the country with the lowest mortality rate in each injury category. There is no specific pattern of association between Gross Domestic Product and incidence of motor‐vehicle accidents by category of road user, whereas fatality from motor‐vehicle accidents seems to be inversely, strongly and significantly related to Gross Domestic Product.

Conclusion: The ongoing development of large injury databases in the European Union is a prerequisite for understanding the complex interactions that lead to a childhood injury. Moreover, possible remedies for overcoming the genuine problems associated with the application of traditional epidemiologic methods to the investigation of the frequently transient in nature causes of injuries should be considered.
Spontaneous growth in German children and adolescents with genetically confirmed Prader‐Willi syndrome
Authors: Hauffa BP , Schlippe G , Roos M , Gillessen‐Kaesbach G , Gasser T
Published: August 2010

Height and weight in children with Prader‐Willi syndrome, diagnosed by standard clinical criteria, follow a specific developmental pattern resulting in early childhood obesity, absent pubertal growth spurt and adolescent short stature. New molecular techniques (methylation analysis, fluorescence in situ hybridization) now allow the unequivocal diagnosis of Prader‐Willi syndrome (PWS). We investigated the possibility of a bias in syndrome‐specific growth standards based on clinically diagnosed patients by comparing these standards with new standards derived from 100 German patients with molecularly confirmed PWS, none of whom had received a growth‐promoting therapy. Height centile curves of the German patients fall in the tall range of standards derived from American patients. This is mainly due to an elevation of the lower centile ranges in both sexes. When the height standards derived from German patients are compared to those of a large multinational cohort of patients, 78% of whom were not confirmed by genetic testing, only minor differences in the height centiles become apparent. The population background therefore does not appear to play a major role for the observed differences. In a marked proportion of patients a decreased sitting height/height ratio is found. This was usually associated with scoliosis. Weight standards from our study group show that after 14 y of age German girls with PWS are heavier than their American counterparts. Standards for the body mass index of German patients of both sexes are increased over normal reference standards (p <0.0001) and do increase with age (boys: p = 0.0038; girls: p = 0.0004). PWS genotypes or sex had no apparent influence on SDS for height, weight and body mass index.

Conclusions: Because of the observed differences to other growth standards, use of the newly constructed centile curves is advocated in German patients with molecularly confirmed PWS to avoid delay in the diagnosis of additional growth‐compromising conditions.
Potential role of colour‐Doppler cystosonography with echocontrast in the screening and follow‐up of vesicoureteral reflux
Authors: Ascenti G , Chimenz R , Zimbaro G , Mazziotti S , Scribano E , Fede C , Ricca M
Published: August 2010

Primary vesicoureteral reflux is a predisposing factor for urinary tract infections in children. The first‐choice technique for the diagnosis of vesicoureteral reflux is voiding cystourethrography, followed by cystoscintigraphy; cystoscintigraphy, however, has the advantage of only minor irradiation of the patient, but it does not allow the morphological evaluation of bladder and vesicoureteral reflux grading. Colour‐Doppler cystosonography with echocontrast is a recently introduced method for imaging vesicoureteral reflux. The aim of our study is to evaluate the role of colour‐Doppler cystosonography with echocontrast in the diagnosis of vesicoureteral reflux. Twenty children (11M, 9F) aged between 0.4 and 4.9 y underwent colour‐Doppler cystosonography using a diluted solution of Levovist® (Schering, Germany), after filling up the bladder with saline. In all patients, vesicoureteral reflux diagnosis and grading had been performed previously by voiding cystourethrography within 5 d from ultrasonography. Our data showed high accuracy in the detection of medium to severe vesicoureteral reflux (grades III‐V), confirmed by radiological features in 9/9 patients. Conversely, in the 11 patients with mild vesicoureteral reflux (grades I‐II), this technique showed extremely low sensitivity, allowing diagnosis in only four cases.

Conclusions: Colour‐Doppler cystosonography, because of the absence of ionizing radiations, has great advantages, particularly in patients needing prolonged monitoring. Despite experiences reported in the literature, this technique has a role in the diagnosis of vesicoureteral reflux. Our group chooses colour‐Doppler cystosonography for the follow‐up of medium‐severe grade vesicoureteral reflux already diagnosed by radiology and/or scintigraphy. Cystoscintigraphy is employed only to confirm cases resulting negative at ultrasonography.
Central apnoea and endogenous prostaglandins in neonates
Authors: Hoch B , Bernhard M
Published: August 2010

Aim: Central apnoeas without an identifiable precipitating cause frequently occur in the neonatal period. Serious apnoeas should be treated with ventilation‐enhancing methylxanthines. Drugs such as opioids or prostaglandins (PGE2) are known to induce apnoea. PGE2 is an endogenous hormone that plays an important role in the regulation of neural activity and a relationship between PGE2 and central apnoeas has been postulated. Methods: In order to test the hypothesis that the incidence of central apnoeas in preterm infants is related to endogenous PGE concentration, we measured the urinary concentration of PGE2 and PGE‐M and determined the number of central apnoeas >10s/12h in overnight polygraphy in 18 preterm infants with apnoeas, bradycardias and desaturations, and 18 normal controls. Results: We found 80.6 (SE 6.9) central apnoeas in the study group, and 52.9 (SE 4.1) in the control group (p= 0.002). Urinary PGE2 concentration was 25.9 (SE 6.1)ng/h/1.73m2 in the control, 31.2 (SE 15.8) ng/h/1.73m2 in the study group (p= n.s.), PGE‐M concentration was 486 (SE 35) ng/h/1.73m2 in the control and 1132 (SE 131) ng/h/1.73m2 in the study group (p < 0.0001). There was a significant correlation between the number of central apnoeas and the PGE‐M concentration in the study group (r= 0.68, p < 0.0001).

Conclusion: Our results suggest a relationship between PGE and the respiratory system and open potential therapeutic options for the treatment of central apnoeas in neonates.
Epidemiology of invasive pneumococcal infections in children aged 0–6 years in Denmark: a 19‐year nationwide surveillance study
Authors: Kaltoft MS , Zeuthen N , Konradsen HB
Published: August 2010

The impact of the new pneumococcal conjugate vaccines on invasive disease burden in Danish children was evaluated by analysing the results from the last 19 years of a nationwide surveillance of invasive pneumococcal infections. During 1981–1999, the Streptococcus Unit at Statens Serum Institut, Copenhagen, received 1123 invasive pneumococcal isolates from children aged 0–6 years. Nearly 72% (71.8%) of the pneumococcal isolates were from children aged <2 y. The median ages of children with pneumococcal meningitis and bacteraemia were 10.2 mo and 15.9 mo, respectively. The incidence of pneumococcal meningitis remained stable during the study period. The mean annual incidence rates of pneumococcal meningitis among children aged <1, <2, and <7 years were 17.4, 12.4, and 4.3 per 100000, respectively, during 1981–1999 (overlapping age groups are used throughout this article to facilitate the comparison of incidence data from different countries or among different studies). The annual incidence of pneumococcal bacteraemia increased from 1981 to 1996, after which a slight fall was noted. During the last six years of the study period, the mean annual incidence rates of bacteraemia were 30.1, 32.5, and 14.0 per 100000 children aged <1, <2, and <7 years. In the 1990s, pneumococcal isolates with reduced sensitivity to penicillin (0–5% each year) and erythromycin (7.4% in 1999) emerged as a cause of invasive infections in children aged 0–6 years in Denmark. During 1981–1999, 10 serotypes (1, 4, 6A, 6B, 7F, 9V, 14, 18C, 19F, 23F) caused 82% of invasive infections in Danish children. Importantly, no significant temporal changes in overall serotype distribution or differences in serotype distributions between girls and boys could be documented during the study period.

Conclusion: According to the Kaiser Permanente trial, the 7‐, 9‐, and 11‐valent pneumococcal conjugate vaccines will probably cover around 60%, 70%, and 80%, respectively, of all invasive pneumococcal infections in Danish children aged 0–6 y, corresponding to 12–14 episodes of meningitis and 40–60 episodes of bacteraemia per year.
Epidemiology of pneumococcal disease in children in Germany
Authors: Ziebold C , von Kries R , Siedler A , Schmitt HJ
Published: August 2010

Recently published and as yet unpublished data allow a reasonable estimate of the annual burden of pneumococcal disease in Germany. At least 277000 episodes of otitis media and at least 2000 episodes of sinusitis occur in children under the age of 5 y. Pneumococcal meningitis was found in 200 children under the age of 16 y; the estimate for all age groups ranges from 450 to 1100 cases. Of approximately 150000 cases of ambulatory pneumococcal pneumonia, at least 63 000–105000 patients are hospitalized each year.

Conclusion: Further studies of pneumococcal epidemiology in Germany are needed, and continued surveillance will be necessary for a better understanding of the overall burden of pneumococcal disease in children as well as adults.
Epidemiology of invasive childhood pneumococcal infections in Greece
Authors: Syriopoulou V , Daikos GL , Soulis K , Michos A , Alexandrou H , Pavlopoulou I , Pagali A , Hadjichristodoulou C , Theodoridou M
Published: August 2010

A retrospective study was conducted to identify the epidemiologic characteristics of invasive pneumococcal infections among children <14y of age in our geographic region. During a 5‐y period, from 1995 to 1999, 590 cases of invasive pneumococcal infection were identified in Aghia Sophia Children's Hospital, Athens, Greece. The male to female ratio was 1.4:1 and 64% of patients were younger than 5 y of age. The overall annual incidence rate was estimated as 44/ 100000 children <14y of age, whereas the incidence rate for children <5y of age was 100/ 100000. The most common types of infections were pneumonia (472 cases; 133 definite and 339 probable), bacteraemia without focus (79 cases), and meningitis (33 cases). A seasonal variation of invasive pneumococcal infections was noted, with two peaks‐one during spring and the other during autumn. Only two cases with meningitis died and one developed permanent neurological sequelae, representing a case‐fatality rate for meningitis of 6%. Serogroups 14, 19, 6, 18, 23, 4 and 9 were the most prevalent, comprising 77% of 92 serotyped isolates.

Conclusion: Invasive pneumococcal infections cause considerable morbidity in the paediatric population in the Athens metropolitan area. Sixty‐six percent of the serotypes causing invasive pneumococcal disease in our region are included in the 7‐valent conjugate vaccine.
Streptococcus pneumoniae in children in Spain: 1990–1999
Authors: Fenoll A , Jado I , Vicioso D , Berrón S , Yuste JE , Casal J
Published: August 2010

This study analyses the serogroups/types (SGTs) and resistance to penicillin and erythromycin of 3921 strains isolated from 1990 to 1999 in children aged 0–14 y in Spanish hospitals of all the autonomous communities. Based on the age of the children, strains have been divided into five groups: 0–6 mo, <6–1 y, <1–2y, <2–5 y and 5 y. While only eight SGTs were responsible for 80% of the infections in children from 6 mo to 2 y of age, this number increased to 11 and 16 for the groups 2–5 y and <5–14 y, respectively. SGTs 6, 14 and 19 were prevalent in blood and otic exudates. SGTs 1, 4, 5, 12 and 18 were more frequent in invasive disease but serotype 3 was clearly associated with otitis. Serotypes 1 and 5 were quite significant in children of over 2 y of age, and this should be taken into account in future vaccine formulations.

Conclusion: Although high, the rate of penicillin resistance in the paediatric population has remained stable in recent years. Conversely, erythromycin resistance is still increasing in our country. Coverage by the 7‐valent vaccine was 78 and 81% for blood and otic isolates, respectively. These coverage levels would be increased by 9% and 3% if 9‐valent (plus 1 + 5 serotypes) were used and by an additional 2.6% and 7.6% using the 11‐valent (plus 3 + 7) formulation.
Islet cell antibody frequency differs from that of glutamic acid decarboxylase antibodies/IA2 antibodies after diagnosis of diabetes
Authors: Borg H , Marcus C , Sjöblad S , Fernlund P , Sundkvist G
Published: August 2010

The combination of glutamic acid decarboxylase (GAD) 65 antibodies (GADA) and protein tyrosine phosphatase‐like protein IA2 antibodies (IA2‐ab), measured by radioligand binding assays, has been suggested to replace islet cell antibodies (ICA), measured by indirect immunofluorescence, as a marker for autoimmune type 1 diabetes. The aim of this study was to compare the frequency of ICA and GADA and/or IA2‐ab not only at, but also after the diagnosis of diabetes. ICA, GADA and IA2‐ab were therefore assessed at and up to 11 y after the diagnosis of diabetes in 86 children (1‐15‐y‐old). At diagnosis, ICA were found in 74 (86%) and GADA and/or IA2‐ab in 79 (92%) of the diabetic children. Hence, there was no major difference in frequency between ICA and GADA and/or IA2‐ab at diagnosis of diabetes. At follow‐up, however, ICA were less frequent than GADA and/or IA2‐ab; 1–3 y after diagnosis ICA were found in 12 (44%) and GADA and/or IA2‐ab in 24 (89%) of 27 children (p = 0.001); 4–6 y after diagnosis ICA were found in 7 (24%) and GADA and/or IA2‐ab in 27 (93%) of 29 children (p < 0.0001); 7–11 y after diagnosis ICA were found in 4 (13%) and GADA and/or IA2‐ab in 21 (70%) of 30 children (p < 0.0001). We conclude that the frequency of ICA does not always correspond to that of GADA and/or IA2‐ab. Many years after diagnosis of diabetes, measurements of GADA and IA2‐ab, but not ICA, detect autoimmunity in high frequency.
Head growth in Rett syndrome
Authors: Hagberg G , Stenbom Y , Engerström I Witt
Published: August 2010

The longitudinal development of head growth was investigated in girls with Rett syndrome. Measurements were taken retrospectively from different kinds of records. Growth retardation was expressed in standard deviation (SD) scores. In classic types, the mean head circumference fell successively to 2 SD scores below the norm at the age of 4 y. After the age of 8 y it stabilized close to –3 SD scores. The degree of deceleration correlated strongly to the age at which a deceleration of 1 SD score had occurred. In forme fruste variants, the mean head circumference was within normal limits; however, it was significantly below the norm (–0.8 SD scores). Body height deviated to –2 SD scores at the age of 6 y and was highly correlated to decline in head growth. When head growth was related to the severity of motor disability, there was a continuum from almost normal head growth with well‐preserved gross motor function and some preserved fine motor function to a marked deceleration in head growth with maximum gross and fine motor disability.
A study of breathing pattern and ventilation in newborn infants and adult subjects
Authors: Al‐Hathlol K , Idiong N , Hussain A , Kwiatkowski K , Alvaro RE , Weintraub Z , Cates DB , Rigatto H
Published: August 2010

Experimentally modified breathing pattern in human subjects, by varying the inspired gas mixture or administering different neuromodulators, has been studied extensively in the past, yet unmodified breathing has not. Moreover, most data refer to infants during sleep and adults during wakefulness. We studied the baseline breathing pattern of preterm infants [n= 10; GA 30 (27–34) wk (median, range)]; term infants [n= 10; GA 40 (39–41) wk)], and adult subjects [n= 10; age 31 (17–48) y)] during quiet sleep. A flow‐through system was used to measure ventilation. We found: (i) instantaneous ventilation was 0.273 ± 0.006, 0.200 ± 0.003, and 0.135 ± 0.002 Lmin‐1.kg‐1 in preterm, term infants, and adult subjects; the coefficients of variation were 39%, 25%, and 14% (p <0.01). The greater coefficient of variation in neonates compared to adults related to increased variability in Vt (39% and 25% in preterm and term infants vs 14% in adults; p < 0.01) and f (39% and 22% vs 9%; p < 0.01). The major determinant of frequency in preterm infants was Te (81% variability), Ti varying less (25% variability); (ii) VT/Ti decreased and Ti/Ttot increased with age; (iii) the higher breath‐to‐breath variability in preterm infants was associated with larger changes in alveolar PCO2 and a larger variability in O2 saturation than later in life.

We conclude: (i) the high breath‐to‐breath variability in frequency in preterm infants closely relates to variation in Te; (ii) decreased effective inspiratory timing (Ti/Ttot) in preterm infants compared with adults likely reflects their high pulmonary impedance; and (iii) greater breath‐to‐breath variability in ventilation in neonates with large variations in alveolar PCO2 and O2 saturation remains when compared with values in the sleeping adult. We speculate that high variability in Te early in life represents an effort to maintain lung volume through increased post‐inspiratory diaphragmatic activity and increased upper airway resistance in an attempt to avoid collapse due to poor chest wall recoil.
A multicenter collaborative study on the risk factors of cardiac sequelae due to Kawasaki disease: a one‐year follow‐up study
Authors: Oki I , Tanihara S , Ojima T , Nakamura Y , Yanagawa H
Published: August 2010

Objective: To measure the prevalence of cardiac sequelae 1 y after the onset of Kawasaki disease and determine the risk factors associated with these cardiac sequelae. Material and methods: 1594 patients who initially visited one of the 87 target hospitals in 1996 for Kawasaki disease participated. Selection of the target hospitals was based on a nationwide survey. The patients were followed‐up and information concerning cardiac sequelae occurring within 1 y of onset was obtained by mail survey. Results: The prevalence of cardiac sequelae 1 mo after onset was 10.2% and decreased to 4.2% in 1 y. The prevalence was higher among males than females and higher in patients less than 1 y and 5 ys or older than in 1–4 year‐olds. Of the patients with cardiac sequelae at 1 mo, the sequelae disappeared in 60.7% after 1 y. Analysis revealed low serum albumin as a risk factor related to the occurrence of cardiac sequelae 1 y after onset. Of the 1594 patients, 10 had giant anuerysms and 3 had a fatal outcome.

Conclusions: Approximately 60% of cardiac sequelae due to Kawasaki disease that developed within 1 mo after onset disappeared in 1 y. The odds ratio was significantly higher among patients with a low serum albumin level 1 y after onset.
Insulin‐like growth factor binding protein‐3 proteolysis and growth of athyreotic infants in the first weeks of life
Authors: Zamboni G , Antoniazzi F , Tatò L
Published: August 2010

To gain a better understanding of the growth of athyreotic newborns in the first weeks of life, we evaluated auxological parameters and determined the serum levels of growth hormone (GH), insulin‐like growth factor I (IGF‐I) and free IGF‐I, and IGF‐binding protein‐3 (IGFBP‐3) in 15 hypothyroid infants (10 females) at a mean age of 25 d of life, immediately before the beginning of L‐thyroxine therapy, and at 3 and 6 mo of life. Fourteen normal infants (9 females) of the same age were studied as controls. IGFBP‐3 proteolytic activity was evaluated in 8 patients and in 8 controls at 25 d and 6 mo of life. There was no significant difference concerning weight and length between the patients and controls at birth, 25 d, 3 and 6 mo of life. The blood GH, IGF‐I and IGFBP‐3 levels were significantly lower in patients at diagnosis than in controls of the same age (p < 0.01 for all parameters), as well as IGFBP‐3 studied by Western blotting. At diagnosis, the patients’free IGF‐I level was within the control range, but the free IGF‐I percentage of total IGF‐I was higher than in the controls (p, < 0.01). IGFBP‐3 proteolytic activity was found to be greater in the patients (p < 0.01). At 6 mo of life, after therapy, none of these parameters was different from those of the controls.

Conclusion: Increased IGFBP‐3 proteolytic activity in our patients at diagnosis, favouring IGF‐I bioavailability, could account for normal free IGF‐I levels and in turn for their normal growth pattern during the first weeks of life and before the start of treatment.
Anti‐endotoxin antibodies in human milk: correlation with infection of the newborn
Authors: Feist N , Berger D , Speer CP
Published: August 2010

A longitudinal study was performed to investigate the content of human colostrum and milk of antibodies against endotoxins of Escherichia coli, Pseudomonas aeruginosa and Salmonella minnesota during the first 6 mo of lactation. The influence of the gestational age of the newborn and the prevalence of a systemic infection in the child on maternal antibody production were observed. Colostrum of mothers of term infants who had shown signs of systemic infection contained higher antibody concentrations compared to colostrum of mothers of healthy newborns. After the first week post partum, no difference in the milk's antibody content could be observed between these two groups. Antibody titres rose from 2 wk to 6 mo post partum (p < 0.001). Milk of mothers of preterm infants with signs of systemic infection contained higher antibody titres than milk of mothers of preterm infants without infection throughout the observation period. This difference reached statistical significance 3 wk after delivery (p < 0.05). The corrected endotoxin antibody levels against all tested antigens in milk of mothers of preterm infants with infection 6 mo post partum were 6 ± 3.5 times as high as 2 wk post partum.

Conclusions: Breast milk contains anti‐endotoxin antibodies. The particularly high levels of anti‐endotoxin antibodies in cases of neonatal infection may present a special maternal protection for premature infants.
Serum cortisol concentrations in ill preterm infants less than 30 weeks gestational age
Authors: Heckmann M , Wudy SA , Haack D , Pohlandt F
Published: August 2010

Adrenal insufficiency is suspected in some ill preterm infants. The aim of this prospective study was to compare serum cortisol concentrations during the first 2 wk of life of well preterm infants (group A) less than 30 wk of gestational age with the cortisol concentrations of ill preterm infants whose arterial hypotension—a potential sign of adrenal insufficiency—had been treated with catecholamine (group B), and the cortisol concentrations of ill preterm infants who had not been so treated (group C). Cortisol concentrations did not differ significantly between group A (240 nmol/l, 58–659; n= 46) (median, minimum‐maximum) and group C (268 nmo/l, 58–1007; n= 25). Group B had a double‐peaked distribution of cortisol. Two subgroups were formed by taking the highest cortisol level of group A as a threshold: group B1 (110 nmol/1, 41–378; n= 20) and group B2 (1200 nmol/l, 764–1482; n = 8). The cortisol concentrations of group B1 were significantly lower (p= 0.00097) compared to the cortisol concentrations of the well preterm infants (group A). The seventy of illness, which was quantified by two scoring systems, differed significantly among the groups (p < 0.003 for all comparisons) with the following sequence: A < C < B, but not between B1 and B2, as clinical variables were not different between the subgroups.

In conclusion, when clinical signs of adrenal insufficiency, such as severe arterial hypotension, were not found in ill preterm infants, serum cortisol concentrations were not different from those of well preterm infants. Seventy‐one percent of preterm infants with catecholamine‐treated arterial hypotension had significantly lower cortisol concentrations, which may reflect adrenal insufficiency, but no differences in the seventy of illness were found between infants with high and low cortisol levels.