bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors associated with the duration of breastfeeding: analysis of the primary and secondary responders to a self‐completed questionnaire
Authors: Pande H , Unwin C , Håheim LL
Published: January 2008

A cohort of 1192 consecutive newborn infants was followed prospectively for factors possibly affecting the length of time they were breastfed. Following the procedure of a double‐blind test, one‐third of the cohort received Credé prophylaxis at age 2 h. The duration of breastfeeding (sole or partial) was recorded up to age 6 months and there was a 100% follow‐up. Multivariate proportional hazards regression analysis (Cox) of the whole cohort showed that babies being delivered between 21.00 and 24.00 h were associated with a shorter duration of breastfeeding (rate ratio = 1.37, 99% confidence interval=1.05‐1.78). Mother's age (under 21 years), marital status (unmarried) and birthweight (inversely) were factors also independently associated with shorter breastfeeding duration. Boys were breastfed for a shorter time than girls (p < 0.05). In univariate analyses only, the first‐born babies had a significantly shorter breastfeeding time, and purulent eyes in the first 24 h was a factor of borderline significance (p < 0.05). Educational level, socioeconomic status and smoking habits of the mothers were not investigated in this study. Owing to the lack of regulations in place at the time of the study (1981‐82), it was possible to differentiate between the mothers who responded spontaneously to the self‐completion questionnaire (primary responders, 68.5%) and those who required one or two reminders. Short breastfeeding time was the strongest predictor of being a secondary responder, followed by being very young or unmarried. Approaching the secondary responders reduced the prevalence of breastfeeding at 6 months by 5% (from 53.8% to 48.8%).
Parent‐reported symptoms of hyperactivity and attention deficits predict teacher‐reported symptoms
Authors: Zeiner P
Published: January 2008

The object of the study was to examine whether symptoms of attention problems and hyperactivity reported by parents predicted teacher‐reported symptoms in a referred sample of boys with the DSM‐III‐R diagnosis of Attention‐deficit Hyperactivity Disorder (ADHD). Data from 48 boys, 7–12 years, were gathered independently from parents and teachers using the Child Behavior Checklist, Teacher's Report Form and the ADHD Rating Scale. Base rate, positive predictive power and negative predictive power were calculated for each symptom and for clusters of symptoms. The positive predictive power for individual symptoms was reasonably high with a mean score of 80%, while the parent‐teacher agreement (measured by phi correlations) was low. Our results indicate that in most children referred because of hyperactivity, inattention and impulsivity, parent reports are sufficient to make a diagnostic evaluation. However, when multiple informants are available, data should be obtained from different sources.
Differences in height and weight between children living in neighbourhoods of different socioeconomic status
Authors: Jansen W , Hazebroek‐Kampschreur AAJM
Published: January 2008

Data on height, weight and pubertal development of 8596 Dutch children were taken to study differences in health status between children living in neighbourhoods of different socioeconomic level in Rotterdam. The data were obtained during regular school medical examinations of children aged 5, 7, 11 and 14 years. Children living in poor neighbourhoods appeared to be shorter than children living in rich neighbourhoods. Overweight appeared to be more prevalent amongst children living in poorer neighbourhoods.
Salicylate intoxication using a skin ointment
Authors: Chiaretti A , Wismayer D Schembri , Tortorolo L , Piastra M , Polidori G
Published: January 2008

Acute percutaneous salicylate intoxication is a rare event in children but can happen with a skin disease where salicylic acid, used as a keratolytic ointment, can be absorbed transcutaneously. Until now, few cases of transcutaneous salicylate intoxication have been reported in the literature. Our case report is about a 5‐year‐old girl with lamellar ichthyosis and an acute salicylate transcutaneous intoxication after the application of a skin ointment. The child had a fever, hyperpnoea with respiratory alkalosis, comatose state and oculogyric crisis. We would like to emphasize the danger of applying salicylic acid in children with extensive skin diseases and, therefore, it is advisable to measure the plasma salicylic levels so as to prevent eventual salicylate toxicity.
Effect of training on the aerobic power and anaerobic performance of prepubertal girls
Authors: McManus AM , Armstrong N , Williams CA
Published: January 2008

The purpose of this study was to investigate the effects of two, three times a week, 8‐week training programmes on the aerobic power and anaerobic performance of 30 prepubescent girls, with a mean age of 9.6 y. Peak oxygen uptake assessed by an incremental discontinuous treadmill test, and peak power in 5 s and mean power over 30 s estimated from a Wingate anaerobic test were used as the criterion measures. Twelve girls trained using a continuous cycle ergometer programme, 11 girls followed a sprint running programme and the control group consisted of 7 girls. Both training groups significantly (p < 0.05) increased their peak oxygen uptake and peak power in 5 s. However, the increases reported here are lower than those generally observed in adolescents following training. The control group demonstrated no significant (p > 0.05) change in either variable. No significant (p > 0.05) changes in mean power over 30 s were observed in any group.
Nitric oxide and aneurysm formation in Kawasaki disease
Authors: Iizuka T , Oishi K , Sasaki M , Hatanaka Y , Minatogawa Y , Uemura S , Koike M
Published: January 2008

The objective of this study is to show that nitric oxide plays a role in the development of coronary artery abnormalities in Kawasaki disease. We examined nitrite + nitrate, biopterin and neopterin in 316 urine samples of 34 patients with Kawasaki disease, those of 24 patients with other diseases, and those of 25 healthy children acting as a control group, because urinary nitrite + nitrate are reportedly useful as markers of nitric oxide generation in vivo, and pathways for neopterin‐biopterin synthesis and nitric oxide generation are tightly coupled. In our study, the children with Kawasaki disease excreted more urinary nitrite + nitrate and neopterin than did the healthy control group children and excreted abnormally high quantities more often than did the patients with other diseases. Good relationships were found between the urinary nitrite + nitrate levels and the urinary biopterin levels, and between these biopterin levels and the urinary neopterin levels. Nitric oxide is therefore thought to be generated in abnormally high quantities, and to be closely related to the pathology of Kawasaki disease and to the development of coronary artery abnormalities. The role of nitric oxide in Kawasaki disease should be further studied to elucidate the pathophysiology of the disease and to aid in the development of new treatments.
Treatment of adrenoleukodystrophy with bone marrow transplantation
Authors: Malm G , Ringdén O , Anvret M , von Döbeln U , Hagenfeldt L , Isberg B , Knuutila S , Nennesmo I , Winiarski J , Marcus C
Published: January 2008

Three children with adrenoleukodystrophy (ALD) underwent allogeneic bone marrow transplantation (BMT) between 1992 and 1993. The first boy had attention deficits, marked neuropsychological deficits and widespread demyelination in the frontal lobes on MRI before transplantation. Four years later he has mentally deteriorated and the demyelination on MRI has progressed. The second boy had no symptoms but had white matter lesions on MRI when diagnosed. He was regularly followed with MRI and neuropsychological investigations until BMT 18 months later. A progress of the lesions was noted on the initial MRI investigations, and 4 months before BMT a worsening of deficits in attention and kinaesthetic praxis could be observed. He rapidly deteriorated after the transplantation and died 18 months later. Both PCR andin situhybridization confirmed the presence of donor cells in the brain. The third boy had no symptoms but white matter lesions on MRI when diagnosed. The neuropsychological tests remained normal but a slight progress was observed on MRI just before transplantation. This boy is still healthy 3.5 years after BMT. BMT as treatment for ALD has to be considered very early, even in a child without symptoms but signs of demyelination on MRI, if a suitable donor is available.
Thalamic lesions revealed by MR associated with periventricular leukomalacia and clinical profiles of subjects
Authors: Yokochi K
Published: January 2008

Magnetic resonance (MR) findings at the cerebral white matter and the thalamus in 44 children with spastic cerebral palsy born at preterm were analysed. Periventricular leukomalacia (PVL) was found in all of the children. Lesions of the thalamus were revealed in 22 children, 19 of which were in the anterior part of the pulvinar and 3 of which were in other areas. Gestational ages and birthweights of the children with a lesion of the pulvinar were significantly greater than those without lesions of the thalamus. Mental retardation and paroxysmal ocular downward deviation were more frequently seen in the children with a lesion of the pulvinar than in those without lesions of the thalamus. The children with thalamic lesions in areas other than the pulvinar showed the most severe motor and mental disabilities.
The measurement of knee‐heel length in newborn infants using a simple vernier calipers
Authors: Skinner AM , Cieslak Z , MacWilliam L , Solimano A , Kitson HF
Published: January 2008

Objective: To assess the usefulness of a simple vernier calipers for measuring knee‐heel length in neonates. Subjects and methods: Using a simple vernier calipers, knee‐heel length was measured five times by 2 observers in 50 babies (29M, 2IF; mean birthweight 1597 g; median gestational age at birth 29 weeks) at a median postnatal age of 11 days. A subgroup of 20 babies had knee‐heel length measured similarly at weekly intervals for 3 weeks. Corrected gestational age and weight were simultaneously recorded. One observer was experienced in using the vernier calipers. The precision of the calipers was established using 4 steel gauge blocks of varying length (7.62‐10.17 cm). Results: The calipers were very precise when measuring steel gauge blocks. In babies, there was a downward trend across the first 2 measurements for both observers, the measurements stabilizing over the last three. Using the final three measurements per baby (n= 50), the experienced observer had a mean standard deviation of 0.023 cm and mean coefficient of variation 0.23%‐ when measuring an average knee‐heel length of 9.99 cm. The inexperienced observer had a mean standard deviation of 0.057 cm and a mean coefficient of variation of 0.56%, when measuring an average knee‐heel length of 10.14 cm. The inter‐observer reliability, measured by the intra‐class correlation coefficient, was 0.99. The agreement between observers was such that one observer measured knee‐heel length consistently less (0.15 cm. SD 0.18 cm) than the other. The reliability for knee‐heel length velocity was lower (R= 0.85), but agreement between observers was high with an average difference of 0.016 cm/ week. Knee‐heel length was significantly correlated (p < 0.001) with corrected gestational age (r= 0.85) and with weight (r= 0.96). There was a weaker but significant correlation (r= 0.47, p < 0.001) between knee‐heel length velocity and rate of weight gain (g/day), indicating that weight gain may not always be accompanied by an increase in linear growth. Conclusion: The measurement of knee‐heel length by a simple vernier calipers is an accurate, reproducible and non‐invasive method of assessing short‐term linear growth in neonates. However, it is recommended that measurements of knee‐heel length in a individual baby should be made by a single experienced observer.
Bone mineral acquisition in low calcium intake children following the withdrawal of calcium supplement
Authors: Lee WTK , Leung SSF , Leung DMY , Wang S‐H , Xu Y‐C , Zeng W‐P , Cheng JCY
Published: January 2008

Our recent 18‐month calcium supplementation trial demonstrated a significant increase in radial bone mineral mass in 7‐year‐old children with calcium intake ∼ 300 mg/day (Am J Clin Nutr 1994; 60: 744‐50). The persistence of higher bone mass after cessation of calcium supplementation is unknown. This is a follow‐up study to investigate the lasting effect of calcium supplementation on bone acquisition. Subjects were 159 Chinese children aged 8.7 years. Distal one‐third radial bone mineral content (BMC) and bone width (BW) were measured by single‐photon absorptiometry. After 12 months, the significant difference in mean ± SD percentage radial BMC disappeared between the study and control groups (7.34 ± 6.77% vs 8.67 ± 6.46%. p > 0.05). Dietary calcium intakes were similar between the groups. During the supplementation phase, the study group had 17.9% greater BMC gain than that of controls. In the follow‐up phase, however, the study group had 16.1% less BMC gain than that of controls. It appears that an increased acquisition rate during the supplementation phase was almost balanced by a reduced acquisition rate during follow‐up phase. Moreover, throughout the entire 30‐month period, the overall BMC acquisition rates of the study and control groups were 25% and 23.8%, respectively. Hence, the overall acquisition rate of the study group was only 5% higher than that of controls. Therefore, the effect of calcium supplementation on bone mineral gain appears to reflect a transient reduction in bone turnover rate. Longer‐term calcium trials are necessary to confirm whether a sustainable higher calcium intake throughout childhood will enhance peak bone mass.
Factors predicting cerebral edema in young children with diabetic ketoacidosis and new onset type I diabetes
Authors: Hale PM , Rezvani I , Braunstein AW , Lipman TH , Martinez N , Garibaldi L
Published: January 2008

We have attempted to identify any characteristics which could be used to predict the development of cerebral edema in four children under 5 years of age with new onset insulin‐dependent diabetes mellitus and diabetic ketoacidosis. We retrospectively analysed and compared the concentration of serum sodium (corrected for serum glucose value) and effective serum osmolality of these 4 children with values of 10 age‐matched controls with new onset insulin‐dependent diabetes mellitus who did not develop cerebral edema during treatment of diabetic ketoacidosis. The initial serum sodium values of the two groups were not statistically different. Patients who developed cerebral edema had lower initial serum glucose values and effective serum osmolality. During treatment, patients who developed cerebral edema had consistently lower mean serum sodium and osmolality than controls at each 4‐h interval after the first 4 h of therapy. Serum sodium and osmolality declined progressively after the initiation of therapy in cerebral edema patients, while remaining stable in controls. These data suggest that children who develop cerebral edema during treatment for diabetic ketoacidosis initially may have a relatively normal serum osmolality and subsequently develop progressive hyponatremia and/or a trend of declining serum sodium before developing cerebral edema.
Wheezing bronchitis reinvestigated at the age of 10 years
Authors: Wennergren G , Åmark M , Åmark K , Óskarsdóttir S , Sten G , Redfors S
Published: January 2008

We have reinvestigated 92/101 children aged 10, who before the age of 2 years were admitted to a paediatric ward due to wheezing bronchitis. At the present time, 70% are symptom‐free without medication, 20% have mild asthma, 8% moderate and 2% severe asthma. Persistent asthma correlated significantly to the presence of some other atopic disease in recent years, to early start of wheezing during infancy and to intense obstructive disease as a young child, while initial respiratory syncytial virus infection did not. A clear‐cut relationship between smoking in the home in infancy and persistent asthma emerged (not visible at a preschool follow‐up). The histamine challenge results correlated to the clinical picture. A normal histamine challenge was seen in 63%, mild hyperresponsiveness in 19%, moderate in 12% and pronounced hyper‐responsiveness in 6%. The figures for persistent asthma and bronchial hyperresponsiveness are high compared with the prevalence of asthma in the overall population of schoolchildren.
Nerve conduction and autonomic nerve function in diabetic children. A 10‐year follow‐up study
Authors: Solders G , Thalme B , Aguirre‐Aquino M , Brandt L , Berg U , Persson A
Published: January 2008

In order to study the long‐term development of diabetic neuropathy in children with newly diagnosed diabetes mellitus, 144 children were entered in a prospective study of nerve conduction and autonomic nervous function. Neurophysiological recordings of nerve conduction and parasympathetic function (R‐R variations) were made at onset of diabetes and after 2, 5 and 10 years. Low sensory nerve conduction and autonomic dysfunction were found in approximately 25% of the children at onset of diabetes when the patients were not yet in complete remission. During years 0–2, an initial improvement of sensory conduction velocities was found. After 2 years, deteriorations in sensory and motor nerve conduction and autonomic nerve function were common and further deterioration was seen over time. A correlation was found between nerve conduction and glycaemic control.
Dilation mechanism, causes of restenosis and stenting in balloon coarctation angioplasty
Authors: Ino T , Ohkubo M
Published: January 2008

This review focuses on the individual dilation mechanism, the possible cause of restenosis after balloon angioplasty and the clinical application of a stent in coarctation of the aorta. Balloon angioplasty is still not the first choice of therapy in neonates with native coarctation because of the potential risk of aortic disruption, the high incidence of restenosis and the satisfactory results of surgical coarctectomy. Intravascular ultrasound imaging provides the individual mechanism of aortic dilation by balloon, and this will be a new modality for assessing the relationship between restenosis and aortic luminal morphology after balloon dilation. Although the cause of restenosis after balloon angioplasty remains uncertain, it may be due to a combination of elastic recoil by ductal tissue constriction, intimal hyperplasia and arterial remodelling. A stent could be an effective alternative to conventional balloon angioplasty in native coarctation of the aorta, preventing ductal tissue constriction. However, the problematic relationship between patient growth and relative stenosis of the stent should be clarified before clinical application of a stent for this disease.
Effects of bottle feeding and two different methods of gavage feeding on oxygenation and breathing patterns in preterm infants
Authors: Poets CF , Langner MU , Bohnhorst B
Published: January 2008

Objective To determine the effect of bottle feeding, as compared to two methods of gavage feeding, on apnoea, bradycardia and oxygen desaturation frequency. Patients: Thirty preterm infants breathing room air; gestational age 28.6 ± 2.1 weeks at birth and 34 ± 1.4 weeks at study (mean ± SD). Methods: Nine‐hour recordings of pulse oximeter saturation (SpO2), pulse waveforms, electrocardiogram, breathing movements and nasal airflow. Administration of 21 ± 1.5 ml/kg of milk/feed in 3‐h intervals using three different feeding techniques in random order: bottle feeding, bolus gavage feeding, and slow gavage feeding (1 h). Analysis of recordings for apnoeas (≥4 s, bradycardias (heart rate < 2/3 of baseline), and episodic desaturation (SpO2≤ 80%). Results: There were three times more desaturations with bottle feeding than with bolus gavage feeding (p < 0.001), but no further reduction with slow gavage feeding. With all three feeding techniques, there were significantly more desaturations in the hour when the feeds were given than during the following 2 h. The deleterious effects of bottle feeding were most evident during the hour of feeding, but desaturation frequency remained significantly higher than with gavage feeding during the following 2h. There was no significant effect of feeding technique on the frequency of apnoea or bradycardia. Conclusions: Preterm infants who are normally oxygenated in room air may have significant desaturation during bottle feeding. Such desaturation can be effectively reduced by gavage feeding. Slow gavage feeding offers no advantage over bolus gavage feeding with respect to the avoidance of hypoxaemia.
Neonatal respiratory distress in near‐term infants—consider surfactant protein B deficiency
Authors: Sleight E , Coombs RC , Gibson AT , Primhak RA
Published: January 2008

Two infants presenting with respiratory distress in the first 24 h of life are described. Both patients underwent extensive investigation before the diagnosis of surfactant protein B‐deficiency was reached. Both children died within 2 months of birth. Parental consanguinity was known to be a feature in the first case, who proved to have a previously unrecognized mutation of the surfactant protein B gene. In the second case, a history of parental consanguinity was not sought from the Caucasian family, but was later volunteered by the parents themselves. Case 2 proved to have the “common” surfactant protein B‐deficient genotype. The key to diagnosis is having a high index of suspicion in any term or near‐term newborn with severe respiratory distress; parental consanguinity must be excluded. Surfactant protein B‐deficiency can be readily diagnosed from bronchoalveolar lavage specimens; a simple, inexpensive procedure which is well tolerated in newborns.
Salmonella meningitis: clinical experience of third‐generation cephalosporins
Authors: Huang L‐T , Ko S‐F , Lui C‐C
Published: January 2008

Fifteen paediatric patients with Salmonella meningitis were retrospectively reviewed. Presenting symptoms and signs included fever, vomiting, seizures, poor activity, diarrhoea and bulging anterior fontanelle in most patients. Seven out of eight patients with prolonged fever for > 10 days had neurologic sequelae; therefore, prolonged fever is a significant prognostic factor of a poor outcome (p < 0. 005). All 15 patients had a brain ultrasound or computed tomography in the acute stage and 11 patients had abnormal findings. The 14 surviving patients were treated with a third‐generation cephalosporin for at least 3 weeks. Seven patients (47%) made complete recoveries; two of them were treated solely with a third‐generation cephalosporin. Only one mortality (6%) occurred and there were no relapses. In conclusion, high frequencies of prolonged fever, neuroimaging abnormalities and neurologic sequelae were seen in patients with Salmonella meningitis treated with third‐generation cephalosporins.
Constructional dyspraxia in preterm diplegia: isolation from visual and visual perceptual impairments
Authors: Koeda T. , Inoue M. , Takeshita K.
Published: January 2008

Objective: To evaluate ophthalmological profiles, visual perception and constructional function in preterm children with spastic diplegia (SD) and to clarify their neuropsychological deficits in comparison with a control group. Methods: Thirty‐five SD and 34 control children were investigated for visual acuity, eye position, stereoacuity, depth perception, visual perception, visuo‐spatial construction and constructional praxis. Each of the results was compared among the four groups as SD with and without strabismus, and control with and without strabismus. Results: Strabismic SD showed worse visual acuity, worse stereoacuity and worse depth perception than the other groups. Constructional dyspraxia was detected in 94. 1% of SD either with or without strabismus, while it was rare in the control group. There was no significant contribution of visual acuity, eye position, stereoacuity or depth perception to constructional dyspraxia by stepwise multiple linear regression analysis. Conclusion: Strabismic preterm SD children are at high risk for visual dysfunction. Constructional dyspraxia was frequently found in SD children and may be a dysfunction isolated from ophthalmological and visual perceptual dysfunctions.
Coagulation and fibrinolytic systems in the ill preterm newborn
Authors: Mautone A. , Giordano P. , Montagna O. , Quercia M. , Altomare M. , Mattia D De
Published: January 2008

Aim: The activation pattern of the clotting and fibrinolytic systems in 63 preterm infants (GA 31, 6 ± 2.3 weeks) was studied. Methods: The infants were divided into four groups: (i) IRDS, (ii) asphyxia at birth, (iii) sepsis, and (iv) mild infection. A control group was composed of preterm infants without any apparent disease (GA 32 ± 1.8 weeks). Results: During IRDS we found a systemic activation of both coagulation and fibrinolysis at birth which was represented by lower levels of ATIII (27.7 ± 8.8%) and significantly greater levels of TAT (37.9 ± 31.9 ng/ml), D‐dimers (1242.7 ± 206.9 ng/ml), tPA Ag (10.9 ± 5.3 ng/ml) and PAI Ag (59.9 ± 16.7 ng/ml) than in the control group. In the asphyxiated newborns there were no significant differences from the controls. During their seventh day of life, a significant reduction of all the analysed parameters (TAT, D‐dimers, tPA, PAI) and a significant increase in ATIII were seen in the newborns with IRDS, while no significant modification was observed in the newborns with asphyxia at birth. When the newborns with sepsis were compared with those with mild infection, their TAT and PAI values proved to be significantly higher for the first tests (21.7 ± 18.8 vs 9.2 ± 6.9 μgA and 53.6 ± 14.4 vs 37.7 ± 10.2 ng/ml respectively). During the second tests, 7 days later, only TAT (16.7 ± 14.7 vs 6.3 ± 4 jtg/1) levels remained high while D‐dimers (1094.2 ± 400.6 vs 646 ± 200 ng/ml) and tPA (11.3 ± 8 vs 4.9 ± 2 ng/ml) were significantly higher in the septic group of newborns than those with mild infection. Conclusions: These data indicate that there is an activation of the clotting and fibrinolytic systems both in the initial phase of IRDS as well as during sepsis.
Bedwetting and behavioural and/or emotional problems
Authors: Hirasing RA , van Leerdam FJM , Bolk‐Bennink LB , Bosch JD
Published: January 2008

Objective: To assess the link between enuresis nocturna and the severity of behavioural and/or emotional problems in Dutch children and the course of these problems. Setting: West‐Mine Region in the Netherlands. Subjects and methods: Prospective cohort study involving 66 of the 80 bedwetting children from all 1652 children born in 1983 in this region. After 1 y, contact was still possible with 64 of the enuretics. We used the Dutch version of the Child Behaviour Checklist (CBCL) and a questionnaire about bedwetting. Results: The mean T‐score for Total Problems (CBCL score) in 1992 (M1; mean age 8. 6) was 52. 1, and 1 y later was 49. 2 (M2). There was no significant difference in the CBCL scores for Ml, M2 and a matching group from the Dutch CBCL norm population, either in the group who remained wet or in the group who became dry. There were no differences between the sexes. There was no link between the severity of behavioural and emotional problems and the frequency of bedwetting. However, more children with bedwetting than expected were in the clinical range. Conclusion: There was no difference in behavioural and/or emotional problems between the first and the second measurement and the matching group from the CBCL norm group. There were no differences in behavioural and/or emotional problems between primary and secondary bedwetters, nor were there any consequences related to the frequency of bedwetting.
Early clinical manifestation of glutaric aciduria type I and nephrotic syndrome during the first months of life
Authors: Pöge AP , Autschbach F. , Korall H. , Trefz FK , Mayatepek E.
Published: January 2008

We describe a male patient with glutaric aciduria type I which had already presented during the neonatal period with therapy‐resistant seizures. In the course of the disease, he also developed choreoathetosis and dystonia. The disease was associated with nephrotic syndrome. Renal histology showed signs of a glomerular disorder with shrinking of glomerular tufts, increase in mesangial matrix, proliferation of extracapillary epithelial cells and formation of larger epithelial crescents. The child died at 22 weeks of age due to end‐stage renal failure. This report illustrates an unusual and early clinical manifestation of glutaric aciduria type I and a hitherto unknown association with nephrotic syndrome in early childhood.
Dietary management of acute diarrhea with local foods in a Guatemalan rural community
Authors: Schroeder DG , Torún B. , Bartlett AV , Miracle‐McMahill H.
Published: January 2008

A community‐based, randomized trial was conducted to evaluate a locally available diet for the management of acute diarrhea (n= 99 episodes) in 90 Guatemalan children, 4–42 months of age. The Test Diet (TD), a combination of a semi‐solid pap (maize flour, black beans, oil) and a liquid gruel,Incaparina(maize flour, cotton seed flour, sugar), in addition to breast‐milk and other home foods (group TD,n= 45 episodes) was offered for 14 d and compared to usual home feeding (group HF,n= 54 episodes). Diarrhea episodes after admission were significantly shorter for group TD (median 2. 0 d) than group HF (median 4. 4 d,p= 0. 003) after adjusting for potential confounders. Weight gains did not differ significantly between groups. We conclude that community‐based dietary management of acute childhood diarrhea using energy‐dense, locally available foods is feasible and may shorten diarrhea duration. This may encourage mothers to follow recommendations for continued feeding during diarrhea in developing country environments.
Failure to thrive: the earliest feature of cystic fibrosis in infants diagnosed by neonatal screening
Authors: Giglio L. , Candusso M. , D'Orazio C. , Mastella G. , Faraguna D.
Published: January 2008

The benefits of early treatment of nutritional and respiratory problems in the CF infant and of genetic counselling for the parents are widely recognized. However, clinical diagnosis of CF is often delayed despite early onset of symptoms and the usefulness of neonatal population screening as a preventive measure is still under debate. This study analyses the clinical history of CF patients diagnosed exclusively on the basis of positive neonatal screening tests with the aim of identifying the earliest markers of the disease. We studied 103 CF infants bom in north‐east Italy, diagnosed following neonatal screening: assay of immunoreactive trypsin (IRT) from a heel‐prick blood sample followed by a measurement of meconium lactase in cases with raised IRT. Diagnosis was confirmed by sweat test at an average age of 39 days. Eighty‐one patients (79%) had symptoms strongly suggestive of CF at diagnosis, and signs and/or symptoms of pancreatic insufficiency were present in 16 of the remaining 22 cases. The most frequent symptom was growth failure (69% of infants) and of these. 44% weighed the same as at birth or less. Pancreatic insufficiency was confirmed by the low level of faecal chymotrypsin found in 85% of cases. IRT was elevated in all cases. CF had not been suspected in any symptomatic infant, although most of the infants had been monitored by a paediatrician. In conclusion, most infants with CF diagnosed by neonatal screening are already symptomatic in the first six weeks of life and the most frequent symptom is failure to thrive; pancreatic insufficiency was already present in most cases. In areas without CF neonatal screening programs, the disease should be excluded by differential diagnosis in all cases with growth failure notwithstanding adequate caloric intake in the first months of life. The high sensitivity, low cost and simple execution of IRT and fecal chymotrypsin tests make them an ideal first step in suspect cases before proceeding to the sweat test, often performed late because of limited availability.
Age governs gender‐dependent islet cell autoreactivity and predicts the clinical course in childhood IDDM
Authors: Örtqvist E. , Falorni A. , Scheynius A. , Persson B. , Lernmark Å
Published: January 2008

Most IDDM patients temporarily restore some of their beta‐cell function following the initiation of insulin therapy. The aim of this study was to analyse the influence of age, gender, metabolic state at diagnosis and presence of autoantibodies (GAD65 antibodies and IC A) on the duration of the clinical partial remission. In total, 149 consecutively diagnosed IDDM children, 0–16 y old (70F, 79M, mean age 9. 5 y) were studied. Partial remission was arbitrarily defined as the period when the insulin dose was below 0. 5 U/BW 24h‐1 and HbA1c below 7. 5%, and occurred in 119/149 patients with a duration between 1 and 38 months. Cox's regression analysis showed that the factors significantly associated with the duration of remission were age, gender, interaction between age and gender, ICA and a high initial HbAlc, whereas GAD65Ab had no influence. Young boys had the shortest remission period, while adolescent boys had the longest, as compared to young and adolescent girls. The IC A‐negative patients (n= 42) had a longer remission period (median 9. 7 months) than the ICA‐positive children (n = 107; 5. 0 months; p = 0. 0001), regardless of GAD65Ab status. We speculate that the relative insulin resistance, which is more pronounced in pubertal girls than in boys, may be associated with a more rapid increase of exogenous insulin requirement. These findings are important when evaluating the effect of islet cell autoreactivity on the clinical course of IDDM in children.
Perinatally acquired brachial plexus palsy–a persisting challenge
Authors: Bager B.
Published: January 2008

The aim of this investigation was to study the contemporary pattern of perinatally acquired brachial plexus palsy (BPP) in Sweden. National incidence data were collected from the Swedish Medical Birth Registry. The clinical pattern of BPP was studied in the county of Skaraborg. All children (n= 52) with confirmed neonatal BPP in 1981 ‐89 were assessed 4–14 y after birth using routine neonatal and follow‐up documentation for retrospective analysis and an assessment battery for the clinical evaluation of impairment. The mothers' recollection of the birth process was recorded by interview and compared with two control groups. The incidence of BPP in Sweden increased significantly from 1. 4 per mill in 1980 to 2. 3 per mill in 1994. The incidence was 45 times higher at a birthweight of >4500 g than at a birthweight of < 3500 g. Fifty percent had a birthweight exceeding the mean + 2 SD. In the Skaraborg series, half the children had normalized arm‐hand function after 6 months (mean) and half had stationary impairment from 15 months (mean). Twenty‐two percent of the children had severe stationary impairment of arm‐hand function according to the criteria. There was no correlation between birthweight and the level of impairment. One‐third of the newborn infants with BPP had neonatal care related to the difficult birth process and perinatal distress. The mothers of the children recalled the birth process as being difficult or very difficult in 77% compared with 20 and 27%, respectively, in the two control groups. This population‐based investigation has revealed an unexpected increase in BPP in Sweden and has confirmed that BPP continues to be a significant cause of motor handicap in children.
Is smoking in pregnancy interrelated between generations?
Authors: Hofvendahl E. , Hofvendahl S. , Wallander B.
Published: January 2008

In order to compare pregnancy smoking habits in two generations, data on first generation deliveries in 1964–67 were obtained from prospective questionnaires. By record linkage with the Swedish Medical Birth Registry, data on daughters giving second generation births (n= 1659) were obtained, including prospective smoking information. The catchment area was that of Helsingborg County Hospital (population 145 000). Second generation births until December 31, 1993 were identified in all of Sweden. The odds ratio of maternal smoking in the first generation for pregnancy smoking among the daughters was significantly increased and approximately doubled. Adjustment for confounders was made using the Mantel‐Haenszel method. Similar odds ratios remained after stratification either for a social environment index of the first generation or the educational level of the second generation. Thus, our data suggest a biological association between pregnancy smoking habits over generations. Research on causative mechanisms could help design more efficient intervention programs. In a separate analysis of two parturient cohorts in Helsingborg 30 y apart, we found that the prevalence of maternal smoking had decreased comparatively more among younger than older women.
Audit of neonatal intensive care transport–closing the loop
Authors: Leslie AJ , Stephenson TJ
Published: January 2008

To audit the effectiveness of changes in transport arrangements, data on babies ventilated during transfer into a neonatal unit were compared between two periods. During the first period, August 1991 ‐February 1993, an ad hoc transport team operated. Transport practice was changed in 1993 by forming a nine‐person nursing transport team, improving training and upgrading monitoring. The second audit period was January 1994‐July 1995. The groups were not significantly different for birth weight, gestation or levels of ventilation. Physiological variables were assessed with a “transport score”. Improved scores for temperature and pH were achieved on completion of transfer in 1994–95 compared to 1991–93. Stabilizing prior to transfer took longer in the 1994–95 period. No serious deteriorations occurred in transit in the 1994–95 period, three in 1991–93. Audit facilitates identification of problems in transport. Staff, education and equipment changes were associated with improved audited outcomes.
Multicore myopathy with restrictive cardiomyopathy
Authors: Willemsen MAAP , van Oort AM , ter Laak HJ , Sengers RCA , Gabreëls FJM
Published: January 2008

A 10‐y‐old girl is presented who suffered mild muscular weakness and exercise intolerance from the age of 1 y onwards, with progression appearing from the age of about 8 y. Multicore myopathy and restrictive cardiomyopathy were diagnosed. Literature concerning the coexistence of multicore myopathy and cardiomyopathy is reviewed.
Bronchopulmonary dysplasia and oxidative stress: are we closer to an understanding of the pathogenesis of BPD?
Authors: Saugstad OD
Published: January 2008

In recent years a body of data has accumulated, linking the development of bronchopulmonary dysplasia (BPD) to increased oxidative stress in the first few days after birth, since high concentrations of metabolites reflecting increased peroxidation products such as pentane, ethane, protein carbonyl, o‐tyrosine, allantoin and F2‐isoprostanes, as well as low levels of glutathione and sulfhydryl/total protein ratio, also reflecting increased oxidative load, have been found in the premature infants at risk of or developing BPD. Oxidative stress seems to increase lung antioxidants in some experimental models of BPD and hyperoxia affects foetal lung growth. There are similarities between inflammation and hypoxia/reoxygenation, since both activate a number of inflammatory mediators such as cytokines and adhesion molecules, some of which are found in high concentrations in tracheal aspirate fluid of infants developing BPD. Surfactant production and function are also altered by both hyperoxia and reactive oxygen species per se, making the lungs more vulnerable to injury. This new knowledge may result in new and more efficient therapeutic approaches, hopefully leading to the eradication of BPD in the near future.
Myths and facts about breastfeeding: does it prevent later atopic disease?
Authors: Vandenplas Y.
Published: January 2008

Exclusive human milk feeding during the first 6 months of life, with delayed introduction of solids, is the recommended feeding for human infants. Human milk reduces the incidence and morbidity related to infection and allergy to cow's milk proteins. Dietary maternal restrictions during (late) pregnancy or lactation cannot be recommended, but may be advised in special cases. A maternal elimination diet seems more effective if associated with environmental hypoallergenic intervention(s). Milk from mothers consuming cow's milk proteins contains small amounts of beta‐lactoglobulin, which appear to introduce in the majority of infants both atopic and non‐atopic tolerance rather than sensitization. However, it is uncertain whether breastfeeding also reduces the incidence of later atopic disease, since its aetiology is multifactorial.
Markers of oxidative stress and antioxidant activity in plasma and erythrocytes in neonatal respiratory distress syndrome
Authors: van Zoeren‐Grobben D. , Lindeman JHN , Houdkamp E. , Moison RMW , Wijnen JT , Berger HM
Published: January 2008

Markers of oxidative stress and antioxidant activity in plasma and erythrocytes were studied for 14 d after birth in infants with neonatal respiratory distress syndrome (n= 9) and controls (n= 36). In plasma, the total radical trapping antioxidant capacity and the chain‐breaking antioxidants vitamin C, sulfhydryl groups and bilirubin were similar. The differences in uric acid levels were not consistent, but vitamin E levels and vitamin E/total‐lipid ratio were lower in the neonatal respiratory distress group (p < 0.01). In erythrocytes, the antioxidant enzymes glutathione peroxidase, glutathione reductase and superoxide dismutase did not differ postnatally. Indicators of oxidative damage in plasma (sulfhydryl/protein ratio and thiobarbituric acid reactive substances) showed the same postnatal course in both groups and were not influenced by oxygen therapy. In erythrocytes the reduced/oxidized glutathione ratio showed no consistent differences. In conclusion, this study, using erythrocytes and plasma, does not provide convincing evidence of oxidative damage and diminished antioxidant defenses in preterm infants with neonatal respiratory distress syndrome.
Early postnatal hypoglycaemia in newborn infants of diabetic mothers
Authors: Stenninger E. , Schollin J. , Åman J.
Published: January 2008

This study found that early postnatal hypoglycaemia was mainly induced by foetal hyperinsulinaemia, in close relation to maternal hyperglycaemia. even in well‐controlled pregnancies of 59 mothers with insulin‐treated diabetes mellitus, 29 with insulin‐dependent diabetes mellitus and 30 with gestational diabetes mellitus. Ten of the newborn children (17%) had a blood glucose concentration below 1.0mmol 1‐1 at 2h postnatally. Cord insulin‐like growth factor‐1 or glucagon concentrations were not related to the early decline of blood glucose.
Malnutrition, cell‐mediated immune deficiency and acute upper respiratory infections in rural Bangladeshi children
Authors: Zaman K , Baqui AH , Yunus Md , Sack RB , Chowdhury HR , Black RE
Published: January 2008

A community‐based longitudinal study conducted in rural Bangladesh investigated the association between nutritional status, cell‐mediated immune status and acute upper respiratory infections (URI). A total of 696 children aged 0–59 months was followed prospectively for 1 y yielding 183 865 child‐days' observation. Trained field workers visited each child every 4th d and collected morbidity data on symptoms suggesting URI (cough, fever, nasal discharge) for the preceding 3 d by recall. On the day of visit they examined each child reporting cough and/or fever to record the temperature, presence of nasal discharge, rate of respiration and presence of chest indrawing. Anthropometry for all children was conducted monthly. Cell‐mediated immune competence was assessed by a multiple antigen skin test at baseline and thereafter every 3 months. The incidence of URI was 5. 3 episodes per child‐year observed. Approximately three‐quarters of the study children were below ‐2 Z‐score weight for age and height for age, and a quarter below ‐2 Z‐score weight for height. During different test periods 9–21 % of the study children did not respond to any of the test antigens. In a regression model children < ‐2 Z‐score for weight for height had 16% [odds ratio (OR) 1. 16, 95% confidence interval (CI) 1. 03–1. 31, p= 0. 01] higher risk of developing URI. Anergic children had 20% higher risk (OR 1. 20, CI 1. 05–1. 38, p= 0. 009) of URI than immunocompetent children. The study demonstrated that wasting and depressed cell‐mediated immunity (CMI), but not stunting, were associated with the incidence of URI among rural Bangladeshi children.
Quality of life in children with congenital heart defects
Authors: Laane K Møyen , Meberg A , Otterstad JE , Frøland G , Sørland S , Lindstrom B , Eriksson B
Published: January 2008

Quality of life was measured in children with congenital heart defects (CHDs) registered in a total population of infants born live in the period 1982–91 (n= 22 810), using essential life spheres: external living conditions, interpersonal and personal conditions. In 200 children with CHD alive at the time the investigation was performed, 164 (82%) of the families answered a questionnaire addressing different dimensions of these quality of life spheres. Three subgroups of CHDs were investigated: CHDs spontaneously cured (n= 80), CHDs treated by surgery (n= 56), and CHDs with associated syndromes/ malformations (n= 29). 301 (75%) out of 400 controls, matched for age and habitat (county), answered the same questionnaire. The children's ages at investigation were 2y 2 months‐12y 2 months (median 6y 1 month). There were no statistically significant differences between the CHD groups and the controls for overall quality of life for any of the three life spheres (p > 0. 05). In children with operated CHDs and CHDs associated with syndromes/malformations, quality of life was influenced at some aspects of the external as well as at the interpersonal and personal levels. A trend existed for a higher subjective experience of quality of life in the total CHD group as well as in all the subgroups. It is speculated that this may represent development of coping mechanisms and recalibration of values of life.
The burden of nocturnal enuresis
Authors: Schulpen TWJ
Published: January 2008

Nocturnal enuresis is a well‐known‘’low‐severity high‐prevalence“ condition in paediatrics, with extensive psychosocial suffering. This suffering is not always realized by paediatricians and other professionals. The aim of this study is to show that enuresis not only has an impact on the child, but also frustrates the entire family. The literature shows that nocturnal enuresis causes distress and low self‐esteem for the child. It also has major social and economic implications for the family, with an increasing intolerance as the child grows older. An analysis of nine studies on the impact of successful treatment on the psychological condition of enuretic children showed improved behaviour and personality scores. In five studies the improvement in mental health was significantly related to treatment success. Timely treatment will prevent psychosocial damage, favour a normal development of the child and bring practical relief to the family.
Formal retrospective case review and sudden infant death
Authors: Byard RW , MacKenzie J , Beal SM
Published: January 2008

A review of 24 consecutive sudden infant deaths was undertaken to evaluate the importance of the various stages in the postmortem assessment of such cases. Death in three cases was caused by obvious trauma. Of the remainder, 16 were attributed to sudden infant death syndrome (SIDS), 4 to accidental asphyxia (identified by death scene examination and/or formal case review) and 1 to a lingual thyroglossal duct cyst. Three (14%) of 21 deaths thought to be SIDS after postmortem examination were attributed to asphyxia following subsequent formal case review.