bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of target height estimated and final height attained between Swedish and Hong Kong Chinese children
Authors: Luo ZC , Low LCK , Karlberg J
Published: August 2010

Target height, the genetic potential in stature, is commonly estimated by the corrected midparental height (CMH) method. A new model for estimating target height has recently been introduced based on a large, Swedish, population‐based study. The aim of this study was to compare the validity of the two methods for estimating target height in Hong Kong Chinese children. The Hong Kong Chinese were more than 10 cm shorter than the Swedes in stature. The secular increase in height over the two generations, however, was 4.2‐4.8 cm for the Hong Kong Chinese, much larger than that of the Swedes (0.7‐1.0 cm). The two populations are thus at different stages in the secular trend. The new model derived from Swedish population for estimating target height was shown to be applicable to Hong Kong Chinese children; the mean of residual final height values was close to zero (–0.15 cm, p = 0.74). However, the mean of residual final height was significantly above the expected value of zero (4.5 cm, p < 0.0001) when the CMH method was applied to the data, which implies an underestimation bias of 4.5 cm. Consequently, if the CMH method is used to estimate target height and evaluate growth hormone treatment responses in short children, it may inflate the treatment response by 4.5 cm. In conclusion, the recently proposed model for target height estimation offers a better alternative for estimating target height in Hong Kong Chinese children and for assessing growth‐promoting treatments.
Nasopharyngeal carriage of meningococcus and meningococcal meningitis in Sokoto, Nigeria
Authors: Emele FE , Ahanotu CN , Anyiwo CE
Published: August 2010

In an attempt to determine the epidemiology of meningococcal diseases in Sokoto, Nigeria, nasopharyngeal carriage of meningococcus was studied among the groups at the greatest risk of the disease, i.e. children and young adults. Of 726 subjects sampled, 45 (6.2%) carried meningococcus. Sixteen (35.6%) of the 45 isolates belonged to serogroup B. Others were as follows: group A, 8 (17.8%), C, 5 (11.1%), D, 1 (2.2%) and non‐groupable 11 (24.4%). Clinical cases encountered during the period were caused by serogroups A (5, 62.5%) and C (3, 37.5%). A male:female carriage ratio of 1.2:1 was recorded for the potential epidemic serogroups, A and C (χ2= 1.0091; p > 0.05), while the clinical case ratio for the genders was 1.8:1 (χ2= 16.1619; p < 0.001). The 5–9‐y‐old age group carried meningococci more frequently (8.5%) than other age brackets, and also registered the highest incidence (46.5%) of the cases. Closeness of contact with a clinical case increased the carriage of the strain of the case (χ2= 33.3940; p < 0.001). Rural dwellers carried meningococcus more frequently than urban dwellers (χ2= 9.5591; p < 0.05). The season had no consistent influence on carriage rates, even though it significantly influenced the outbreaks of the disease. Mass vaccination with polysaccharide vaccine and improved living conditions appear to be the most practical ways to control meningococcal diseases in Africa.
Mutation distribution and CYP21/C4 locus variability in Brazilian families with the classical form of the 21‐hydroxylase deficiency
Authors: Paulino LC , Araujo M , Guerra G , Marini SHVL , De Mello MP
Published: August 2010

Deficiency of adrenal steroid 21‐hydroxylase is the most common form of congenital adrenal hyperplasia and it is considered to be responsible for 90% of the disease. This paper describes for the first time the CYP21B mutation profile in Brazilian patients. We genotyped 41 families with at least one individual affected with the classical form of the 21‐hydroxylase deficiency, representing 74 unrelated alleles. In order to characterize different disease‐causing alleles, genotyping was performed by Southern blot analysis with three restriction enzymes, allele‐specific oligonucleotide hybridization, and allele‐specific PCR. Different alleles were distinguished by TaqI C4B RFLP, gene duplications or deletions of either CYP21A + C4B or CYP21B + C4B, large gene conversions and eight mutations that might have been introduced into CYP21B from CYP21A by microconversion events. At least one mutation was detected in 24 different disease‐causing alleles, which represents about 85% of the affected alleles in those families. The frequency of the 30 kb deletion of CYP21B was lower than that described for Caucasians. The mutation Sp2 showed the highest frequency (24.65%) and was present mainly in salt‐wasting patients, although it was also detected in some patients with the simple virilizing form of the disease. Conversely, I172N showed a frequency of 18.91% and was found mostly in patients affected with the simple virilizing form of the disease. Five other mutations were determined at low frequency, but CL6 was not found in any of the tested alleles.
Serologic response to Bartonella henselae in patients with cat scratch disease and in sick and healthy children
Authors: Not T , Canciani M , Buratti E , Dal Molin G , Tommasini A , Trevisiol C , Ventura A
Published: August 2010

Indirect fluorescent antibody assay (IFA) is the most reliable test for detecting antibody to Bartonella henselae in the diagnosis of cat scratch disease (CSD). Recently, an ELISA test has been proposed, but conflicting results are reported. We compared IgG‐IFA and IgG‐IgM ELISA methods in CSD patients and in healthy children. We also tested ELISA specificity in a large group of healthy controls and in children with lymphoma‐associated lymphadenopathy and with pyogenic lymphadenitis. The ELISA procedure was positive in 69/78 patients with CSD (sensitivity 89.6%), in 5/100 healthy children (specificity 95%), in 2/51 patients with non‐Hodgkin's lymphoma or pyogenic lymphadenitis (specificity 96%) and in 27/296 blood donors (specificity 91.6%). In 34 patients with CSD, ELISA IgM and IgG responses decreased significantly between time of diagnosis of the disease and recovery. We found significantly higher IgG‐ELISA titres in cat‐owners, whether blood donors or healthy children, than in non‐cat‐owners. The IgG‐IFA test gave positive results in 69/78 patients with CSD (sensitivity 89.6%) and in 5/62 healthy controls (specificity 92.5%). The ELISA method is a cheap, sensitive method for determining antibody response to Bartonella henselae infection and is also important for evaluating the clinical course of the disease and the efficacy of antibiotic therapy. The high specificity of ELISA in patients with non‐Hodgkin's lymphoma will help the clinician to exclude a potentially life‐threatening disease associated with lymphadenopathy.
Gallbladder contraction in familial dysautonomia
Authors: Broide E , Strauss S , Kimchi NA , Abramowich D , Bishara M , Scapa E
Published: August 2010

The impaired function of the autonomic nervous system in patients with familial dysautonomia (FD) is frequently associated with gastrointestinal dysfunction. This study sought to determine whether gallbladder contraction is also affected in these patients. Nine consecutive patients with FD were assessed by real‐time ultrasonography for gallbladder volume and calculated percentage of gallbladder contraction before and 45–60 min after a 50 g fatty meal, and compared with nine healthy control patients, matched for age and gender. Gallbladder volume before the fatty meal was found to be larger in healthy controls than in FD patients (25.4 ± 9.5 and 15.4 ± 7.4 ml3, respectively; p= 0.024). No significant difference was demonstrated between the groups after the fatty meal (controls: 12.1 ± 6.0; FD: 9.0 ± 6.6 ml, respectively) and the calculated percentage of gallbladder contraction was similar in both groups (controls: 53.4 ± 16.6; FD: 44.8 ± 18.8%). These results indicate that gallbladder function in FD patients does not differ from the general population and preventive measures for gallstone formation are not required.
Response to methylphenidate in boys with attention‐deficit hyperactivity disorder
Authors: Zeiner P , Bryhn G , Bjercke C , Truyen K , Strand G
Published: August 2010

The response to methylphenidate was examined in 36 boys, aged 7–11 y, with attention‐deficit hyperactivity disorder (ADHD) in a double‐blind, placebo‐controlled, crossover design. Hyperactivity and conduct problems were significantly reduced during methylphenidate treatment. Stimulant medication was associated with improvements on tests of sustained attention, working memory and motor steadiness. When individual changes were studied, it was found that 83% showed a significant improvement in their hyperactivity at home or at school, and for 60% their levels of hyperactive behaviour were within the normal range. High levels of hyperactivity at school and relatively low age were significant predictors of normalization of hyperactivity in at least one setting. However, these predictors could only classify correctly 71% of the children. In clinical practice a trial with stimulants is indicated in ADHD children who show symptoms that are sufficiently severe to cause impairment at home and at school.
Heart risk associated with weight loss in anorexia nervosa and eating disorders: risk factors for QTc interval prolongation and dispersion
Authors: Swenne I , Larsson PT
Published: August 2010

Risk factors for QTc interval prolongation and dispersion, indicators of an increased risk for cardiac arrhythmia and sudden death, have been investigated in patients with eating disorders (ED) and ongoing weight loss. Patients were characterized with regard to weight, body mass index (BMI; weight/length2), duration of weight loss, rate of weight loss and rate of weight loss immediately preceding examination. At examination, a 12‐lead electrocardiographic (ECG) registration and blood samples for analysis of serum electrolytes were obtained. In total, 92 examinations in 58 female patients aged 15.5 ± 1.7 (mean ± SD)y were analysed. Control ECG recordings were obtained from 38 normal‐weight teenage girls with no known heart disease. Patients with ED weighed 40.7 ± 7.8 kg, corresponding to BMI 15.2 ± 2.4 kg/m2 following a weight loss of 11.8 ± 6.5 kg. In ED patients, the ECG showed bradycardia, a shift to the right of the QRS axis, diminished amplitudes of the QRS complex and T wave, and prolongation and increased dispersion of the QTc interval. In multiple regression analyses low weight, low BMI and rapid weight loss immediately preceding the examination were the most important independent predictors of QTc interval prolongation and dispersion. It is concluded that an ECG examination is an important part of the assessment of patients with ED and ongoing weight loss, even in the absence of electrolyte disturbances, and especially if the patient is severely underweight or weight loss is rapid.
Different race, different face: minor anomalies in Chinese newborn infants
Authors: Tsai F‐J , Tsai C‐H , Peng C‐T , Wu J‐Y , Lien C‐H , Wang T‐R
Published: August 2010

Objective: To define the nature and incidence of minor anomalies in Chinese newborn infants and to evaluate the validity of the hypothesis that infants with three or more minor surface anomalies will also have a major malformation. Methods: A total of 3,345 Chinese newborn infants were examined based on a list of 67 items of minor anomalies. Results: About 44.9% of the newborn infants had at least one minor anomaly that was unrelated to gender, maternal age, or gestational age, but significantly associated with fetal presentation. Breech‐presented newborn infants had double the risk of minor anomalies. Simian crease, upward slant and frontal bossing could be considered normal variants for Chinese newborn infants, because the incidence of each was higher than 4%. Conclusions: Although some studies have shown that approximately 90% of infants having three or more minor anomalies are associated with a major malformation, we found only a 10.1% predictive value based on this study. Nevertheless, we suggest that infants with three or more minor anomalies be carefully evaluated for the possibility of major malformation in order to provide early management.
Blood immunoreactive trypsinogen concentrations are genetically determined in healthy and cystic fibrosis newborns
Authors: Lecoq I , Brouard J , Laroche D , Férec C , Travert G
Published: August 2010

Newborns with cystic fibrosis (CF) have increased blood immunoreactive trypsinogen concentrations. When screening for CF in the newborn by immunoreactive trypsinogen measurement, an abnormally high proportion of healthy ΔF508 carriers is found among false‐positive neonates, suggesting that a relationship could exist between immunoreactive trypsinogen concentration at birth and the genetic status. Therefore, this study analysed the possible relationships between neonatal blood immunoreactive trypsinogen concentrations and genotype in 1842 healthy newborns and 111 CF patients detected by a neonatal screening programme. A close correlation was found between immunoreactive trypsinogen and ΔF508: the probability of a healthy newborn being a carrier of this mutation increased regularly with the neonatal immunoreactive trypsinogen concentration. In CF patients, there was a significant difference between ΔF508 homozygotes and ΔF508/X (X = other mutation) compound heterozygotes with respect to the mean neonatal blood immunoreactive trypsinogen concentration. CF neonates with two mutations affecting the nucleotide binding domains of the cystic fibrosis transmembrane conductance regulator protein had significantly higher mean immunoreactive trypsinogen concentrations than patients with one mutation affecting a membrane‐spanning domain. The data strongly suggest that the neonatal immunoreactive trypsinogen concentration is, in part, genetically determined, with a wide range of variations, similar to the features which have been shown for the relations between the genotype and clinical phenotypes of CF patients.
Humane Neonatal Care Initiative
Authors: Levin A
Published: August 2010

The author has worked for many years in experimental departments in the former Soviet health system. Now, with integration into the western health system, many questions are being asked about high‐technology neonatal medicine and whether it is sufficiently humane. The Baby Friendly Hospital Initiative (BFHI) movement is well known all over the world, but unfortunately it is only used for healthy children in maternity hospitals. A paradoxical situation has been created: the routines of maternity wards comply with the BFHI, whereas a neonatal intensive care unit in the same hospital may not meet the requirements of the BFHI. BFHI mainly cover breastfeeding in maternity hospitals. Humane Neonatal Care Initiatives include minimum aggressive therapy, minimum contact between sick newborns and medical staff, and maximum contact with mothers; the number of tests and examinations should be reduced to a minimum. Eleven steps towards the improvement of psychosocial and medical care in units for sick newborns are presented. This article is intended to provoke serious discussion.
Thoughts about rates of breastfeeding
Authors: Koçtürk T , Zetterström R
Published: August 2010

Socio‐economic and other factors which influence the duration of breastfeeding have been reviewed. We agree with the conclusion of WHO's multinational study that breastfeeding is a biological type of behaviour with deep roots in human societies, although there are great variations across settings.
Increased height in diabetes mellitus corresponds to the predicted and the adult height
Authors: Scheffer‐Marinus PD , Links TP , Reitsma WD , Drayer NM
Published: August 2010

This study was conducted to analyse the effect of childhood‐onset diabetes mellitus on adult height. The height at time of diagnosis of 35 children with insulin‐dependent diabetes mellitus (IDDM) was compared with growth reference data. Predictions of the adult height were made at the time of diagnosis using the target height and the Tanner‐Whitehouse II method. The adult height was compared with both the predicted values and the height of healthy adults. The height at time of diagnosis of the prepubertal children was increased compared with growth reference data, in contrast to pubertal children who had normal heights. Only the prepubertal boys were taller at time of diagnosis. The adult height of the prepubertal patients was taller than growth reference data. The mean adult height in all patients did not differ significantly from the predicted heights. In conclusion, the increased height at the start of IDDM in prepubertal children persists until adulthood.
Factors associated with the duration of breastfeeding amongst women in Perth, Australia
Authors: Scott JA , Aitkin I , Binns CW , Aroni RA
Published: August 2010

Duration of breastfeeding was studied in 556 women delivering at 2 maternity hospitals in Perth, Australia. At discharge 83.8% of women were breastfeeding their infants, including 6% who were giving complementary feeds. At 3 and 6 months, 61.8% and 49.9%, respectively, were still breastfeeding. In a Cox survival analysis of factors associated with duration of breastfeeding a positive association was found with maternal education, age and intended duration of breastfeeding. Male infants were more likely to be weaned before female infants and women whose partners were unemployed, or did not have a preference for breastfeeding, breastfed for shorter duration. There is still a need for programmes which support and encourage breastfeeding, focusing particularly on younger, less well‐educated women who intend to breastfeed for less than the recommended 4–6 months.
Pain evaluation in preschool children and by their parents
Authors: St‐Laurent‐Gagnon T , Bernard‐Bonnin AC , Villeneuve E
Published: August 2010

The accurate assessment of pain in children constitutes a challenge for health professionals and, in the case of young children, parents are generally the main source of information. The objective of this study was to validate and to compare three pain scales in preschool children and their parents. A total of 104 children between 4 and 6 y of age and their parents participated in the study while undergoing an immunization procedure in the outpatient department of a tertiary pediatric care hospital. Three pain scales were used, the McGrath Facial Affective Scale (FAS), the Hester Poker Chip Tool (HPCT) and the Multiple Size Poker Chip Tool (MSPCT). There were 47 (45%) boys and 57 (55%) girls, with 54 (52%) 4‐y‐olds, 34 (33%) 5‐y‐olds and 16 (15%) 6‐ y‐olds. Twenty‐eight children (27%) had memories of pain experienced during a former hospitalization. Correlations were very high both in children (r= 0.78) and their parents (r= 0.96) when comparing immunization pain scores obtained from the HPCT versus the MSPCT. Correlations between McGrath's FAS and HPCT or MSPCT ranged from r= 0.34‐0.43 in children and r= 0.38‐0.39 in parents. There was a good correlation between parents and children during the immunization procedure on all three scales, with the highest correlation using the FAS (r= 0.76), followed by the MSPCT (r= 0.69), and the HPCT (r= 0.66). Subgroup analyses based on the criteria of age, sex and previous hospitalization showed no consistent relationship. Parents tended to underestimate their child's pain when using HPCT or MSPCT. It seems that both HPCT and MSPCT measure a similar dimension of pain, whereas the FAS addresses a different aspect of pain. Although parents play an important role in their child's pain assessment, they tend to underestimate the intensity of pain when using HPCT or MSPCT.
Trends in overweight and obesity among 18‐year‐old males in Sweden between 1971 and 1995
Authors: Rasmussen F , Johansson M , Hansen HO
Published: August 2010

The aims of the study are to analyse Swedish trends in overweight and obesity–as measured by body mass index (BMI)–between 1971 and 1995, and to examine socioeconomic and geographic differences between groups of individuals on the basis of information on 18‐y‐old military conscripts. The study population comprises all males born in 1953, 1958, 1963, 1968, and between 1973 and 1977, reported to be living in Sweden at 17 y of age according to nationwide population registers (RTPs). Utilizing the unique personal ID number, sociodemographic data in the RTPs and in Population and Housing censuses were linked to data on BMI in the national Military Service Conscription Registry for the years 1971 to 1995. These data were obtained from compulsory medical examinations held at military induction at 18 y of age. BMI data were available for 448 732 (89%) of a total of 503 689 subjects. Mean BMI increased by 6.6% over the study period–from 21.1 kg/m2 in 1971 to 22.4 kg/m2 in 1995. Unadjusted trend analyses showed a 2.4 times increase in the prevalence of overweight among 18‐y‐old males over the period–from 6.9% in 1971 to 16.3% in 1995. Over the same years, the prevalence of obesity increased 3.5 times– from 0.9% to 3.2%. After adjustment for muscle power, demographic factors, and living area, the prevalence of overweight was found to have increased 1.4 times, and obesity 1.7 times between 1971 and 1993. The prevalence of overweight was considerably higher among 18‐y‐old males from low‐educated families than among those from high‐educated families in both 1971 and 1995. The prevalence of overweight was also found to be higher in both 1971 and 1995 among young men from rural and/or sparsely populated areas than among those living in Sweden's largest cities. Mean BMI, and the prevalence of overweight and obesity have increased among 18‐y‐old males in Sweden over the last 24 y. The increased risk of overweight among young men from low‐educated families and those from rural and/or sparsely populated areas detected in 1971 was still evident in 1995.
Outcome of congenital lung abnormalities detected antenatally
Authors: Lacy DE , Shaw NJ , Pilling DW , Walkinshaw S
Published: August 2010

To determine the outcome of congenital lung abnormalities, data were collected retrospectively between January 1991 and December 1996 on any foetus found to have a lung lesion on antenatal ultrasound. A total of 23 foetuses had lung lesions on antenatal ultrasound. In two foetuses the antenatal ultrasound showed bilateral enlarged “bright” echogenic lungs with evidence of hydrops. Both pregnancies were terminated and tracheal atresia was confirmed. In 15 foetuses the antenatal ultrasound appearance was of a unilateral “bright” echogenic lung. There was one case of bronchial atresia and two cases of congenital lobar emphysema, which all had surgery. In nine cases there was a reduction in the size of the lesion on serial antenatal ultrasounds and no lesion was detected after birth. In three cases a small lesion was present after birth on chest radiography. In six foetuses the antenatal ultrasound appearance was of unilateral cystic or mixed cystic and echogenic lung lesions. Two pregnancies were terminated; both had congenital cystic adenomatoid malformation. Four pregnancies were continued and three infants had surgery soon after birth and were confirmed to have had congenital cystic adenomatoid malformation. One infant has been managed conservatively. In conclusion, a definitive diagnosis cannot usually be made antenatally. A large lesion on initial scan does not necessarily predict a poor outcome. The natural history of small asymptomatic postnatal lesions is unknown and a long‐term prospective study is needed to determine the outcome of these lesions.
Effects of early reduced light exposure on central visual development in preterm infants
Authors: Roy M‐S , Caramelli C , Orquin J , Uleckas J , Hardy P , Chemtob S
Published: August 2010

The aim of this study was to determine, in infants born at <29 weeks postmenstrual age until 32 weeks postmenstrual age, whether reduction to light stimulation by occlusion of eyes affected central visual development. The pattern visual‐evoked potential responses at 41 and 51 weeks postmenstrual age and 3 y of age did not differ between infants subjected or not to ocular occlusion. Hence, an early marked reduction in light stimulation in preterm infants does not seem deleterious to visual development.
Is oral albuterol effective for acute cough in non‐asthmatic children?
Authors: Bernard DW , Goepp JG , Duggan AK , Serwint JR , Rowe PC
Published: August 2010

Fifty‐nine non‐asthmatic children with acute cough were randomized to receive oral albuterol or placebo for 7 d. There was a similar, rapid rate of resolution of acute cough for the two groups, but more shaking or trembling in those treated with albuterol (5/30 vs 0/29; p = 0.05). In ambulatory children with acute cough who have no history of asthma and a normal chest examination, oral albuterol does not reduce the frequency or duration of cough.
Neonatal screening for cystic fibrosis: present and future
Authors: Wilcken B , Travert G
Published: August 2010

Despite there being effective tests for detecting cystic fibrosis (CF) using newborn screening blood samples, screening in neonates has not had universal approval because of uncertainty about its benefits. After up to 18 y experience, at a recent conference in Caen several aspects attracted universal agreement. There is still major delay in clinical diagnosis after the onset of symptoms. There is short‐term benefit in early diagnosis by screening, with reduced morbidity in the first 2 y, evidence of significant nutritional benefits up to the age of 10 y, and probable respiratory benefit over this time frame. There is great potential for research into treatment modalities and no evidence of significant psychological harm to CF babies from early diagnosis. With a screening protocol that includes a DNA test there is some unwanted carrier detection and careful genetic counselling is needed. There is no evidence yet that screening will extend the life of CF patients, so some doubts remain as to its overall effectiveness, and there have been no good studies on comparative costs in screened and unscreened cohorts. Even so, the weight of evidence suggests very worthwhile advantages for screened babies and their families. Because of this, it is unlikely that further trials will take place. It may be that the onus now is on those who do not support screening to justify this stance to parents who may favour it.
Neonatal screening: ethical aspects
Authors: Hermerén G
Published: August 2010

The purpose of this paper is to give an overview of the ethical issues raised by neonatal screening for cystic fibrosis and to propose a structure for the ethical analysis of these issues. The structure is based on an analysis of some of the most common shortcomings of ethical analyses. The structure needs to be supplemented by facts about the present state of the art concerning effects and costs of the various screening and treatment alternatives. Such information is provided by other contributions to these proceedings.
Principles and performance: assessing the evidence
Authors: Pollitt RJ
Published: August 2010

Despite the apparent rigour of the systematic review process there are a number of reasons why it may not accurately reflect the true state of current knowledge. For inborn errors of intermediary metabolism in general, the formal quality of literature on treatment is poor, partly because the rarity of the conditions makes systematic study difficult, partly because of the self‐evident evidence paradox with treatments that are so obviously life‐saving, and partly because of the widespread use of biochemical normalisation as a proxy outcome. In the field of newborn screening there is a paucity of formal trials so that assessment must be either by the‘causal pathway’ approach or by reference to screening “criteria”. The causal pathway approach may be misleading in that there are discontinuities, for example in projecting from known incidence (clinically diagnosed cases) to the incidence expected on screening. The criteria‐based approach suffers from qualitative descriptors, such as “important” and “adequate”, with no clear end‐points, whilst in the context of neonatal screening some of the Wilson and Jungner criteria conflict with current evidence‐based views. These problems are illustrated by reference to two reviews recently produced as part of the UK Health Technology Assessment Programme.
Long‐term outcome of 51 liveborn neonates with non‐immune hydrops fetalis
Authors: Nakayama H , Kukita J , Hikino S , Nakano H , Hara T
Published: August 2010

To search for an efficient method of management of non‐immune hydrops fetalis (NIHF), the clinical outcome of 51 newborns with NIHF was retrospectively assessed in a single centre. As the short‐term outcome, the mortality rate was mainly dependent on the causes of NIHF and the presence of pleural effusion. The survival rate of the patients with pleural effusion (7/28; 25%) was significantly lower than that of those without it (14/23; 61%) (p < 0.02). All 7 survivors with pleural effusion were diagnosed antenatally after 29 weeks of gestation and were delivered after 31 weeks of gestation. With respect to the long‐term outcome, 13 (68.4%) of 19 patients who survived beyond 1 y of age showed normal development, 2 mild developmental delay at 1 y of age and 1 mental retardation at 8 y of age, while 3 (15.8%) had severe psychomotor retardation with marked growth failure. Two of these three patients were born as very‐low‐birthweight infants. The follow‐up results indicate that pleural drainage in utero and prevention of premature delivery should be proposed to improve the outcome of NIHF patients.
Suppression of GH secretion in pituitary gigantism by continuous subcutaneous octreotide infusion in a pubertal boy
Authors: Näntö‐Salonen K , Koskinen P , Sonninen P , Toppari J
Published: August 2010

We describe a 12‐y‐old boy with excessive growth hormone and prolactin secretion presumably due to diffuse somatotroph hyperplasia. Until mid‐puberty, his growth rate was under reasonable control, with high‐dose octreotide injections every 8 h combined with a dopamine agonist. As his growth velocity started to increase, the efficacy of continuous s.c. octreotide infusion on GH secretion was tested. Similar total daily doses (600 μg) of octreotide were administered either by incremental s.c. injections at 8 h intervals, or by continuous s.c. infusion, two‐thirds of the amount during night‐time to control the presumed high nocturnal growth hormone (GH) peaks of the pubertal growth spurt. An overnight GH profile showed inadequate suppression of GH levels by incremental injections, while continuous s.c. infusion efficiently brought down the GH secretion. Another somatostatin analogue, lanreotide as a single depot injection was not effective. A 6‐mo trial on the s.c. infusion regimen significantly reduced growth hormone secretion (as judged by IGF‐I and IGFBP3 concentrations), and normalized growth velocity overcoming the pubertal growth spurt. It also caused a decrease in the pituitary size in magnetic resonance images. We conclude that the efficacy of octreotide infusion in suppressing GH secretion is superior to incremental injections with the same dose.
Systemic effects of a short course of betamethasone compared with high‐dose inhaled budesonide in early childhood asthma
Authors: Hedlin G , Svedmyr J , Ryden A‐C
Published: August 2010

Forty children aged 1‐3 y completed a placebo‐controlled study on the effects of 10 d of inhaled budesonide for asthma caused by respiratory tract infection. The effects on symptoms were significantly better in the active than in the placebo group. In 20 of these children the systemic effects of high‐dose inhaled budesonide for 10 d and the effect of a 3‐d course of oral betamethasone on asthma exacerbation were evaluated. Systemic effects were evaluated by measuring morning cortisol in serum and urine, and the bone markers osteocalcin, ICTP (the C‐terminal telopeptide region of type I collagen) and PIIINP (an N‐terminal propeptide of type III procollagen) in serum before and at the end (d 7‐10) of treatment (1600 μg budesonide d−1 for 3 d and 800 μg for 7 d). In 9 children, measurements were taken on d 3 of a 3‐d course of betamethasone (6, 4 and 2 mg) for asthma exacerbation and 14 d later. There were no signs of systemic effects after 7‐10 d of budesonide. After 3 d of betamethasone, serum cortisol decreased from a median of 263 to 26nmoll−1, urine cortisol/creatinine from 19.9 to 7.2 nmol 1−1, osteocalcin from 31.4 to 5.5 μgl−1, ICTP from 19.4 to 8.5 μgl−1 and PIIINP from 12.3 to 5.9 μg 1−1. Two weeks later, the levels were back to normal. In conclusion, short courses of oral betamethasone have pronounced systemic effects, whereas 10 d of high doses of budesonide do not produce significant systemic effects.
Effect of the cyclo‐oxygenase blocker ibuprofen on cerebral blood volume and cerebral blood flow during normocarbia and hypercarbia in newborn piglets
Authors: Pellicer A , Aparicio M , Cabañas F , Valverde E , Quero J , Stiris TA
Published: August 2010

Indomethacin modifies baseline cerebral haemodynamics and metabolism, as well as vasomotor adaptive responses. However, the significance of arachidonic acid metabolites in the regulation of cerebral circulation remains unclear. A study was made of the effect of inhibition of the cyclo‐oxygenase pathway on baseline cerebral haemodynamics and CO2‐induced vasodilation using the more specific cyclo‐oxygenase blocker ibuprofen in a neonatal pig model. Two methods were used: radiolabelled microspheres to measure cerebral blood flow and near infrared spectroscopy to calculate absolute changes in cerebral blood volume. The relationship between CO2‐induced changes in these two haemodynamic parameters was evaluated. Fifteen newborn piglets <7 d old received an i.v. infusion of either ibuprofen (30 mg/kg) (IB group, n= 8) or saline (control group, n= 7). Cerebral blood flow and absolute changes in cerebral blood volume were measured while the piglets were breathing room air at baseline and 30 min after infusion of ibuprofen or saline, and 15 min and 30 min after inducing hypercarbia. Global and regional cerebral blood flow (ml/hg/min) and absolute changes in cerebral blood volume (ml/hg) did not vary between baseline and 30 min after infusion of ibuprofen or saline. During hypercarbia, global and regional cerebral blood flow and absolute changes in cerebral blood volume increased significantly in both the ibuprofen and control groups (p < 0.01). The mean percentage increases in blood flow and blood volume at each measurement were almost identical, with approximately 90% of the increase in both parameters occurring after 15 min of hypercarbia, then reaching a plateau. However, we found no agreement between cerebral blood flow changes and absolute changes in cerebral blood volume. We conclude that ibuprofen did not alter either baseline cerebral circulation or physiological CO2‐induced vasodilation in newborn pigs. We speculate that hypercarbic cerebral vasodilation could be caused either by mediators other than the cyclo‐oxygenase metabolites of arachidonic acid or by a direct effect on vessel walls.
Clinical, pathological and molecular genetic findings in a case of neonatal Marfan syndrome
Authors: Bresters D , Nikkels PGJ , Meijboom EJM , Hoorntje TM , Pals G , Beemer FA
Published: August 2010

An infant with neonatal Marfan syndrome is described who presented with arachnodactyly, distinctive dysmorphic features and prolapse of both atrioventricular valves and dilatation of both the aortic and pulmonary root. She died in cardiac failure shortly after pacemaker implantation, due to dysrhythmia and severe mitral insufficiency. At autopsy, apart from myxomatous changes of the valves and dilated aortic and pulmonary roots, an aneurysm of the sinus of Valsalva of the pulmonary valve and abnormal myxomatous connective tissue surrounding the AV node were also found. Molecular genetic studies showed a point mutation in the fibrillin 1 gene that creates a new N‐glycosylation site, which has been described once before.
Development of perception in action in healthy and at‐risk children
Authors: van der Meer ALH , van der Weel FR
Published: August 2010

Devising effective assessment techniques and therapy for movement disorders in young children requires in‐depth measures of the child's perceptuo‐motor functioning. It is argued that the field of movement disorders can benefit from an ecological approach to perception and action, where perception subserves action and action influences perception. Three notions central to the ecological approach are described and illustrated with our recent research on infant and child perceptual and motor behaviour.
Behavioural effects in female rats of postnatal exposure to sub‐toxic doses of polychlorinated biphenyl congener 153
Authors: Holene E , Nafstad I , Skaare JU , Krogh H , Sagvolden T
Published: August 2010

Polychlorinated biphenyls (PCBs) are widespread environmental contaminants that are also present in human tissues and breast milk. Behavioural disturbances have been reported in both children and animals exposed perinatally to PCBs. The present study assessed the behavioural consequences in female rats of postnatal exposure to the di‐ortho‐substituted 2,2′,4,4′,5,5′‐hexachlorobiphenyl (IUPAC no. 153), which is one of the PCB congeners most frequently detected in human milk. The different groups of mothers were dosed via gavage with 5 mg/kg bodyweight of PCB 153 in corn oil or 5 ml/kg bodyweight corn oil vehicle every second day from day 3 to day 13 after delivery. The exposure did not affect the bodyweight of the dams nor the physical development of the pups. Operant behavioural testing of the female offspring by two different schedules of reinforcement was performed. First, the animals were tested by a multiple schedule with two components: fixed interval (FI) and extinction (EXT), which has proved sensitive in revealing changes in activity level. There were no statistically significant differences in frequency or interresponse times of lever pressing between the PCB‐exposed female rats and the controls. These results were in contrast to a previous, analogous study where PCB 153 produced an increased frequency of lever presses during the FI in male rats, indicating a sex‐specific behavioural effect of PCB 153. The female offspring was also tested by a conjunctive schedule with two components: variable interval (VI) and differential reinforcement of low rate (DRL). This schedule revealed slower acquisition of time discrimination in the PCB 153‐exposed females as compared with the controls. The VI‐DRL results showed that PCB 153 may also produce long‐lasting behavioural effects in female rats following postnatal exposure through the mother's milk.
Storage of human milk and the influence of procedures on immunological components of human milk
Authors: Lawrence RA
Published: August 2010

The storage of human milk for use later by the mother's own infant or an unrelated recipient has an impact on its constituents. These effects involve the storage container, heating, cooling and freezing the milk. Overall, glass is the least destructive container. Milk can be safely refrigerated for 72 h with little change. Freezing destroys cellular activity and reduces vitamins B6 and C. Boiling, in addition, destroys lipase and reduces the effect of immunoglobulin A and secretory immunoglobulin A. The nutrient value of human milk is essentially unchanged, but the immunological properties are reduced by various storage techniques.
Human milk as a carrier of biochemical messages
Authors: Bernt KM , Walker WA
Published: August 2010

Not only does breast milk provides an ideal nutrient composition for the newborn, but it also contains a variety of substances that may actively influence growth and development of the infant and stimulate neonatal protection against gastrointestinal diseases. Hormones, growth factors, cytokines and even whole cells are present in breast milk and act to establish biochemical and immunological communication between mother and child. In addition, milk nutrients such as nucleotides, glutamine and lactoferrin have been shown to influence gastrointestinal development and host defense. The unique properties of milk as a mediator of biochemical messages will be presented and the clinical significance of breastfeeding in the prevention of neonatal gastrointestinal diseases will be discussed.
Human milk and host defence: immediate and long‐term effects
Authors: Hanson LÅ
Published: August 2010

Convincing studies demonstrate significant protection during breastfeeding against diarrhoea, respiratory tract infections, otitis media, bacteraemia, bacterial meningitis, botulism, urinary tract infections and necrotizing enterocolitis. There is also good evidence for enhanced protection for years after the termination of breastfeeding against Haemophilus influenzae type b infections, otitis media, diarrhoea, respiratory tract infections and wheezing bronchitis. In some reports breastfeeding has also improved vaccine responses. Several studies show that milk may actively stimulate the immune system of the offspring via transfer of anti‐idiotypic antibodies and lymphocytes. This may explain why breastfeeding diminishes the risk of developing coeliac disease. Some investigations suggest that there may also be a similar effect on allergic diseases and autoimmune diseases, as well as inflammatory bowel diseases and certain tumours. This needs to be confirmed.
Infantile colic and small intestinal function: a nutritional problem?
Authors: Lindberg T
Published: August 2010

Approximately 25% of infants with moderate or severe colic (crying > 3 h d−1) have a cow's milk‐dependent colic. The author recommends a strict cow's milk‐free diet for the mother (with an extra supplement of calcium) in breastfed infants and a casein‐hydrolysate formula for formula‐fed infants. With this dietary regimen, there will be no nutritional problems. Later in infancy a relatively high proportion of the infants will continue to show an adverse reaction to cow's milk and will also develop allergies to other foods. Several signs (e.g. increased macromolecular absorption, increased motilin levels in serum, increased breath hydrogen excretion, decreased gallbladder contractility) indicate an abnormal intestinal function in colicky infants. The nature of this abnormality is still unknown.
Cow's milk versus formula in older infants: consequences for human nutrition
Authors: Udall JN , Suskind RM
Published: August 2010

Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions. However, modern technology has produced alternative, “humanized formulae”, which closely mimic the composition of human milk. The ingestion of human milk, “humanized formulae” or whole cow's milk has consequences for human nutrition. Gastroesophageal reflux, iron deficiency, calcium and sodium excesses or deficiencies may be influenced by the type and amount of milk fed to the infant. Likewise, neurological development and the likelihood of developing diabetes or cancer may also be influenced by early dietary practices. Until new information is available, we should continue to pattern formulae for older infants after breast milk, but with sufficient protein, calories, lipid and minerals to support optimal growth.
Vitamin K status of lactating mothers and their infants
Authors: Greer FR
Published: August 2010

Vitamin K deficiency remains a world‐wide problem in the newborn. Vitamin K traverses the placenta from mother to infant very poorly and is present only in very low concentrations in human milk. Thus, it is not surprising that the newborn infant has undetectable vitamin K serum levels with abnormal amounts of the coagulation proteins and undercarboxylated prothrombin. Hemorrhagic disease of the newborn, secondary to vitamin K deficiency, remains largely a disease of breastfed infants. Lactating mothers easily achieve the recommended dietary allowance for vitamin K (1 μg kg−1 d−1) and the breast milk concentration is readily increased by increasing maternal vitamin K intake. Breastfed infants do not receive the recommended vitamin K intake via human milk. To prevent vitamin K deficiency in the newborn, intramuscular or oral vitamin K prophylaxis is necessary.
Guidelines for management of children with urinary tract infection and vesico‐ureteric reflux. Recommendations from a Swedish state‐of‐the‐art conference
Authors: Jodal U , Lindberg U
Published: August 2010

There are considerable variations in the management of children with urinary tract infection and reflux. These new guidelines were written after critical review of the literature, but are also based on clinical experience, since there are issues that have not been otherwise adequately studied. The aim is to limit renal damage and future complications, with minimal discomfort to the child, and to avoid unnecessary costs. The recommendations include increased attention to bladder dysfunction, shortening of the time of antibacterial prophylaxis and focus on renal development and function rather than on reflux.
Fatty acid composition of serum cholesterol esters as a reflector of low‐saturated‐fat, low‐cholesterol diet in young children: the STRIP project
Authors: Salo P , Viikari J , Hämäläinen M , Lapinleimu H , Routi T , Niinikoski H , Rask‐Nissilä L , Tammi A , Rönnemaa T , Seppänen R , Jokinen E , Välimäki I , Simell O
Published: August 2010

STRIP (the Special Turku coronary Risk factor Intervention Project) is an ongoing intervention trial which aims at a permanent reduction in the intake of saturated fat and cholesterol starting in childhood. A total of 75 intervention and 63 control children was studied consecutively at the ages of 7 and 13 mo, and 2, 3 and 5 y to evaluate the influence of such intervention on serum cholesterol ester (CE) fatty acid composition, a widely used biomarker of fatty acid intake. Analysis of 4‐d food records showed that total intake of fat and of saturated fat increased with age in both groups of children but was constantly lower in intervention than in control children, e.g. at the age of 5 y the mean intakes of total fat and of saturated fatty acids were 31.1 E% and 33.9 E% and 12.1 E% and 14.6E% in intervention and control children, respectively (p = 0.009 and 0.0001, respectively). Serum CE fatty acid compositions did not differ between the 2 groups at any age; the mean proportion of CE linoleic acid was 52.4% and 52.0% in 5‐y‐old intervention and control children, respectively. Correlation analysis showed, however, that the percentage of linoleic acid and of polyunsaturated fatty acids in CE reflected well the respective dietary intakes (r= 0.36; p = 0.0001 for both coefficients).

In conclusion, CE fatty acid composition did not differ between the intervention and control groups, whereas CE linoleic and total polyunsaturated fatty acids reflected well the differences in their intakes at the individual level.