bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain management in French neonatal intensive care units
Authors: Debillon T , Bureau V , Savagner C , Zupan‐Simunek V , Carbajal R ,   on behalf of the French National Federation of Neonatologists
Published: August 2010

The aim of this study was to investigate pain management in neonatal intensive care units (NICUs) in France and to identify factors associated with variability across units. A questionnaire sent to 143 heads of level II or III NICUs investigated the use of pain scores, pain management organization and pharmacological treatment in five clinical situations (endotracheal intubation, prolonged mechanical ventilation, acute stage of necrotizing enterocolitis, central venous catheter insertion and cephalhaematoma). The response rate was 81%. Among the 35 (30%) units that used no pain scores, 40% ascribed this to lack of knowledge. Factors associated with failure to use pain scores were level II status, no university affiliation, no surgical patients and neonatal patients only. Among the units that scored pain, 78% used valid scores for acute pain and 73% for prolonged pain. Written guidelines were available for acute pain in 65% of units and for prolonged pain in 36%. The rate of pharmacotherapy use varied widely across the five clinical situations studied (from 16 to 77%) and across units for a given clinical situation. Also extremely variable were the regimens used in each situation and the dosages of analgesics and sedatives. Only 11% of units adjusted dosages to gestational age.

Conclusion: Pain assessment was performed in the most French NICUs, but a strong heterogeneity for pain treatment was observed. Reference to recently published pain management guidelines and new randomized trials could be useful to optimize pain treatment in NICUs.
Understanding and circumventing the blood‐brain barrier
Authors: Begley DJ
Published: August 2010

The blood‐brain barrier presents a challenging obstacle to effective drug delivery to the central nervous system (CNS). Although biologically intended to protect the brain and spinal cord and provide a very stable fluid environment, the presence of a blood‐brain barrier makes treatment of many CNS diseases difficult to achieve, as the required therapies cannot be delivered across the barrier in sufficient quantities or at all. Until relatively recently the blood‐brain barrier was viewed largely as a physical barrier to diffusion, and the presence of tight junctions between endothelial cells simply prevented the passive diffusion of solutes from blood into the brain. Recent advances in cell and molecular biology have provided new insights into the function of the blood‐brain barrier and it is now appreciated that, in addition to being a physical barrier, it is a complex transport and metabolic barrier and is a highly reactive and dynamic endothelium. Advances in understanding of the cell biology of the blood‐brain barrier have opened new avenues and possibilities for improved drug delivery to the CNS. The challenges posed by the blood‐brain barrier and the possibilities for overcoming them are reviewed.

Conclusion: Increased understanding of the molecular biology of the blood‐brain barrier is now opening the way for new strategies to deliver drugs to the CNS.
Stress and lack of social support as risk factors for small‐for‐gestational‐age birth
Authors: Pryor JE , Thompson JMD , Robinson E , Clark PM , Becroft DMO , Pattison NS , Galvish N , Wild CJ , Mitchell EA
Published: August 2010

Aim: To determine the contributions of social support and perceived stress to the risk of small‐for‐gestational‐age birth. Methods: The investigation was a case‐control study of mothers of infants born at 37 or more completed weeks of gestation. Cases weighed less than the sex‐specific 10th percentile for gestational age at birth (small for gestational age (SGA), n= 836), and controls (appropriate for gestational age (AGA), n= 870) comprised a random selection of heavier babies. Results: In univariate analyses measures of informal social support, but not perceived stress or formal social support, were associated with SGA birth. It was found that Asian mothers are less likely to receive support from families and friends. After adjustment for ethnicity, informal social support was not associated with SGA.

Conclusions: Support appears to reduce the risk of SGA births, but after adjustment for ethnicity this is no longer the case. Stress during pregnancy was not associated with SGA birth.
Children with nutritional rickets referred to hospitals in Copenhagen during a 10‐year period
Authors: Pedersen P , Michaelsen KF , Mølgaard C
Published: August 2010

Aim: To describe the prevalence of nutritional rickets among children admitted to three large paediatric departments in the Copenhagen area during a 10 y period. Methods: Retrospective analysis of cases identified from the diagnosis registers fulfilling the diagnostic criteria for nutritional rickets. Results: Forty cases were identified, distributed in two distinct age groups: 0.5–4 y (n= 31) and 9–15 y (n= 9). All cases were immigrants, of whom 95% were born in Denmark. The main symptoms in the younger age group were bowed legs and clumsy walk, and in the peri‐pubertal group were painful joints. Two children had generalized convulsions. None of the cases had received vitamin D supplementation.

Conclusion: Nutritional rickets is still present among immigrants in Denmark, and it is likely that the prevalence of mild cases is high. Prevention through vitamin D supplementation is important, but requires a dedicated health education effort.
Frequency of and risk factors for necrotizing enterocolitis in infants born before 33 weeks of gestation
Authors: Hällström M , Koivisto A‐M , Janas M , Tammela O
Published: August 2010

Aim: To investigate the frequency of and risk factors for necrotizing enterocolitis (NEC) among infants of <33 wk of gestation. Methods: Prospective follow‐up of 140 inpatients. Results: 26 (18.6%) subjects developed NEC stage I‐III and 12 (8.6%) severe NEC (stage II‐III). Breast milk fortifier and duration of morphine infusion emerged as the statistically significant factors associated with NEC stage I‐III, but only the latter had a significant association with severe NEC.

Conclusion: Future studies are needed to be established whether morphine is a causative factor in NEC.
Serum thyroglobulin as a marker of thyroid neoplasms after childhood cancer
Authors: Lando A , Holm K , Nysom K , Rasmussen Å Krogh , Madsen M Høier , Feldt‐Rasmussen U , Müller J
Published: August 2010

Aim: To evaluate serum thyroglobulin (Tg) level as a marker of the development of thyroid disease when following individuals who Received neck irradiation therapy in childhood. Methods: In a non‐randomized cross‐sectional study Tg was assessed in 172 survivors of childhood cancer 10.8 y (1.9‐24) median (range) after diagnosis and 7.9 y. (0.9‐24.3) median (range) after the end of treatment. The patients were divided into two groups: group 1 included 47 patients who had Received irradiation to the neck and group 2 included 125 patients who did not receive irradiation to the neck. Results: Patients who had Received irradiation to the neck had significantly higher Tg levels compared with those who did not receive neck irradiation: median 14.0 (1.0–189.0) μg/L vs median 8.8, (0.7–112.2) μg/L (p < 0.001). Six out of seven patients with elevated Tg levels (>70 μg/L) had Received neck irradiation. Among these six patients, two patients developed secondary differentiated thyroid cancer and two patients developed benign thyroid neoplasms. None of the patients who had normal levels of Tg developed thyroid cancer.

Conclusion: A high Tg level should be a cause for further investigation in the follow‐up of individuals who have Received irradiation therapy in childhood.
Hospitalization in Sweden of children born to immigrants
Authors: Danielsson N , Ericsson A , Eriksson M , Källén B , Zetterström R
Published: August 2010

Aim: To study whether excess hospitalization occurs among certain groups of children born in Sweden to immigrant parents. Methods: The study was based on linkage of the Swedish Medical Birth Register 1987–1997 and the Swedish Hospital Discharge Register 1987–1998. Results: Among children whose parents were of Swedish nationality excess hospitalization was found for children of young mothers, parity 3 or more, and if the mother smoked in early pregnancy. These factors were controlled for in the further analysis. Ten years after birth, a large percentage of children born to parents with foreign nationality could not be followed owing to death or emigration (19.9% vs 1.77% of children with Swedish parents). An excess hospitalization of immigrant children up to the age of about 5 y was seen but after that, if anything, these children were hospitalized less. For the whole group of children born to parents of non‐Swedish nationality there was no difference in hospitalization rate after stratification for risk factors and age. When analysis was performed for specific nationalities significantly reduced rates were found for several western European countries while significantly increased rates were seen for the Middle East, north Africa and especially sub‐Saharan Africa (odds ratio 1.57, 95% confidence interval 1.49–1.64).

Conclusion: A moderately increased rate of child hospitalization was only observed for some selected immigrant groups.
Management of vertically HIV‐infected children in Europe
Authors:   European Collaborative Study
Published: August 2010

Aim: To describe policies for the therapeutic management of vertically HIV‐infected children, and to compare these with practice, using children enrolled in a cohort study in the same setting. Methods: A postal questionnaire survey of clinicians in the paediatric centres of the European Collaborative Study (ECS) was used. Prospective data collected within the ECS on the treatment and clinical status of infected children seen in these centres in 1999–2001 were analysed and compared with the year 2000 policies reported. Results: In 3 of the 10 centres, the policy was routinely to administer antiretroviral therapy (ART) to infants upon confirmation of infection, and in 7 centres initiation of therapy was delayed until specific clinical, virological and immunological criteria were reached. Evidence of disease progression was a reason for treatment modification in all centres; other considerations included adherence problems and side effects. However, practice did not always match policy. For the 84 children with at least 5 y of follow‐up (73 treated and 11 untreated), overall, 69% of the 420 person‐years lived were spent without treatment, and 72% without any HIV‐related symptoms. Untreated children were without symptoms for 94% of these 5 y, whereas treated children spent nearly a third of their time with mild or moderately severe symptoms.

Conclusions: Therapeutic management of paediatric HIV disease requires a balance between preventing disease progression and minimizing adherence problems and side effects. This is important, as most infected children are without symptoms most of the time. Recent European consensus guidelines for the treatment of infected children will facilitate management.
Plasma lactate and plasma volume recovery in adults and children following high‐intensity exercises
Authors: Berthoin S , Allender H , Baquet G , Dupont G , Matran R , Pelayo P , Robin H
Published: August 2010

Aim: To compare plasma lactate concentration recovery kinetics when measured and corrected for variations in plasma volume between children and adults. Methods: Nine boys (11.3 ± 1.1 y) and 8 men (21.9 ± 1.9 y) performed a maximal and a supramaximal exercise until exhaustion. Plasma lactate concentrations, haemoglobin and haematocrit were measured at rest, immediately on completion of exercise and after the 2nd, 5th, 12th and 30th minute of recovery. The plasma lactate concentrations and the rate of recovery were corrected for variations in plasma volume. Results: The maximal decreases in plasma volume were significantly higher in adults than in children for maximal exercise (–18.7 ± 2.6% vs – 14.5 ± 3.2%; p < 0.05), but similar for the supramaximal exercise (–16.9 ± 3.4% vs –15.2 ± 3.4%). During recovery, measured and corrected plasma lactate concentrations were significantly higher in adults. The rate of plasma lactate recovery was higher in adults for maximal exercise only. The same results were obtained when the rates of plasma lactate decrease were calculated from corrected plasma lactate concentrations.

Conclusion: The correction of the plasma lactate concentrations for variations in plasma volume did not influence the comparison of the concentrations obtained in adults and children, or their rate of recovery.
Tracking of serum total cholesterol during childhood: an 8‐year follow‐up population‐based family study in eastern Finland
Authors: Fuentes RM , Notkola I‐L , Shemeikka S , Tuomilehto J , Nissinen A
Published: August 2010

Aim: To investigate the tracking of serum total cholesterol (TC) during childhood. Methods: All children born during 1981–1982 in a rural community of eastern Finland were followed at 6 mo, 7 y and 15 y of age. The full follow‐up period was completed by 138 out of 205 children, of whom 82 (33 girls) had TC measured at 7 y and 15 y of age (–7 y, –15 y). The main outcome measurement was TC (mmol/L). Results: TC‐7 y was significantly associated with TC‐15 y (r= 0.655; p‐value <0.001). This correlation did not change significantly after accounting for confounders. Children in the highest tertile of TC‐7y had a significantly higher risk of being in the highest tertile of TC‐15y compared with children in other tertiles of TC‐7 y (relative risk = 6.4 (2.9–13.9)). TC‐15 y was predicted positively by TC‐7 y (linear regression beta = 0.63; p‐value <0.001) and parental high TC (TC ≥5.0 mmol/L in at least one parent) (beta = 0.58; p‐ value = 0.030). Birthweight had no significant association with TC during childhood.

Conclusion: The study confirmed the tracking of TC during childhood. The identification of children at risk of developing high TC during adolescence should take into consideration the child's previous TC values during childhood and parental TC status.
The importance of follow‐up of children with vesicoureteral reflux grade 1
Authors: Grmek M , Fettich J
Published: August 2010

Aim: The objectives of this study were, first, to determine the probability of detecting vesicoureteral reflux (VUR) into the renal collecting system (VUR grade 2 or higher) by follow‐up cyclic radionuclide cystography (CRC) in children with VUR 1 on initial examination, and in children without VUR and with the same clinical history; and secondly, to find out whether dividing VUR 1 into three subclasses, including possible reflux into the ureter, reflux into the lower ureter, and reflux into the whole length of the ureter, enhances detection of higher grade reflux in these children. Methods: 275 children with VUR 1 found on initial CRC, and 31 children without reflux and with the same clinical history were studied. In total, 414 renal units with VUR 1 of different subclasses and 198 renal units without reflux were evaluated. Results: Follow‐up CRC disclosed reflux into the renal collecting system in 20% of children with VUR 1 on initial investigation, and in 23% of children with no reflux at the time of initial investigation. The probability that follow‐up examination would disclose VUR 2 in 3 in renal units with different subclasses of grade 1 reflux was 8–16%, and did not differ significantly from the probability for detecting reflux in kidneys with no reflux on initial examination.

Conclusion: In the absence of recurrent urinary tract infection, the management of children with VUR 1 identified by CRC can be the same as in children without reflux. Yet, in children with no reflux or with VUR 1 detected after urinary tract infection, the probability that reflux reaching the pylon was missed should not be underestimated. Dividing VUR 1 into subclasses does not seem to be of diagnostic value.
Impact of inhaled corticosteroids on the risk of earlyPseudomonas aeruginosaacquisition in cystic fibrosis
Authors: Minicucci L , Severi G , Cresta L , Giannattasio A , Lorini R , Haupt R
Published: August 2010

Aim: To investigate the role of inhaled corticosteroids (IC) on the risk ofPseudomonas aeruginosaacquisition before the age of 10 y in cystic fibrosis (CF) patients.Methods: For each subject the cumulative dose kg‐1of IC received for each year of age was calculated until the end of follow‐up. The age at CF diagnosis, the nutritional status (NS) and the number of respiratory exacerbations (RE) were used as surrogate measures for the severity of CF.Results: A total of 83 patients (40 M, 43 F) entered the study. Their median length of follow‐up was 4.4 y, for a total of 386 person‐years at risk. Twenty‐three patients acquiredP. aeruginosaat a median age of 4.6 y (range 0.4‐9.9 y). The estimated survival withoutP. aeruginosaacquisition was 65% at 10 y of age. The effect of different risk factors (IC, NS, RE and age at CF diagnosis) on the probability ofP. aeruginosaacquisition was evaluated: none of them was significantly associated with the risk ofP. aeruginosaacquisition. In particular, patients receiving very high cumulative doses of IC (4th quartile) had a non‐significantly increased risk ofP. aeruginosaacquisition compared with those receiving low doses of IC (1st quartile) (hazard ratio = 1.73, 95% confidence limits 0.40‐7.38).

Conclusion: This retrospective study was not able to demonstrate any role of IC in increasing the risk ofP. aeruginosaacquisition. This complication seems to occur at a constant pace that is independent of CF severity and age. Prospective multi‐institutional randomized studies are needed to investigate the effects of high‐dose IC in CF patients.
Natural course of preclinical type 1 diabetes in siblings of affected children
Authors: Mrena S , Savola K , Kulmala P , Åkerblom HK , Knip M ,   the Childhood Diabetes in Finland Study Group
Published: August 2010

Aim: To define the dynamics of preclinical type 1 diabetes in siblings of affected children and to characterize the siblings experiencing a progressive process. Methods: From 801 families taking part in the “Childhood Diabetes in Finland” (DiMe) Study, 715 initially unaffected siblings were graded into four stages of preclinical type 1 diabetes based on the initial number of disease‐associated autoantibodies detectable close to the time of diagnosis of the index case, while another classification system covering 641 of the siblings was based on a combination of the initial number of antibodies and the first‐phase insulin response (FPIR) to intravenous glucose. Results: Based on the first classification, there was a total of 95 siblings with initial signs of prediabetes, out of whom 34 (36%) progressed, 26 (27%) remained stable and 35 (37%) regressed during prospective observation for a median of 3.6 y (range 0.01–9.8 y). The siblings who progressed were younger, had a higher initial number of detectable autoantibodies, higher initial levels of various antibodies, with the exception of insulin autoantibodies, lower FPIR and a retarded glucose elimination rate in the first intravenous glucose tolerance test as compared with those that regressed. According to the second classification there were 41 siblings with initial signs of prediabetes, among whom 23 (56%) progressed, 14 (34%) remained stable and 4 (10%) regressed during the observation period.

Conclusion: These data show that almost half of the siblings with signs of prediabetes at the time of diagnosis of the index case progressed further in their preclinical disease process during prospective observation. Young age, a strong humoral immune response to β‐cell antigens and reduced insulin secretory capacity appeared to be characteristic of those with a progressive process. Advanced and late prediabetes seem to represent a point of no return, as regression from these stages to no prediabetes was extremely rare.
Measuring self‐reported, health‐related, quality of life in adolescents with type 1 diabetes using both generic and disease‐specific instruments
Authors: Graue M , Wentzel‐Larsen T , Hanestad BR , Båtsvik B , Søvik O
Published: August 2010

Aims: To describe perceived functional health and well‐being and diabetes‐related impact, worry and satisfaction with life in relation to demographic and clinical variables in a population of adolescents with type 1 diabetes. To compare perceived functional health and well‐being between adolescents with diabetes and a group of healthy controls and to analyse the relationship between generic functional health and well‐being and diabetes‐related impact, worry and satisfaction with life. Methods: A total of 130 adolescents were invited to complete the Child Health Questionnaire (CHQ‐CF87) and the Diabetes Quality of Life (DQOL) questionnaire modified for youths. A total of 115 (88.5%) subjects participated in the study; mean age 14.5 y (SD 1.86), mean duration of diabetes 6.99 y (SD 3.77, range 1–16 y), mean HbA1c 9.3% (SD 1.62, range 6.2–14.0%). Forty‐eight percent of the subjects were girls. Results: When compared with healthy adolescents, subjects with diabetes reported a significantly lower degree of general health. The CHQ‐CF87 scales showed that higher age in adolescents with diabetes was associated with lower scores for mental health (p < 0.001), self‐esteem (p < 0.001), behaviour (p= 0.004) and general health (p < 0.001). Findings from the DQOL questionnaire showed that older adolescents were more worried (p < 0.001), perceived a greater impact of diabetes on daily life (p= 0.008) and lower diabetes‐related life satisfaction (p < 0.001). The scores for girls were lower than those for boys in assessment of mental health (p < 0.001), self‐esteem (p= 0.004) and family cohesion (p= 0.002). Girls also reported a greater impact of diabetes (p= 0.028), more worries (p= 0.001) and less satisfaction with life (p= 0.006) than boys. Neither HbA1c nor other clinical variables could sufficiently explain the variations in DQOL or CHQ‐CF87.

Conclusions: Health‐related quality of life varied significantly by age and gender, but less so by HbA1c and other clinical variables. Adolescents with diabetes reported a significantly lower degree of general health than that reported by healthy controls. The CHQ‐CF87 is a valuable supplement to DQOL, allowing for comparisons with the general population.
Immunogenicity and safety in infants of a DTwPHib full liquid vaccine
Authors: Asensi FI Botet , Veronese A , Otero M Del Carmen , Pérez M Desamparados Tamarit , Lopez JL Hontangas , Viviani S
Published: August 2010

Aim: Combining paediatric vaccines is a rational solution to reduce the number of injections during a single clinical visit, to maintain parents' compliance and to extend vaccine coverage. Different diphtheria, tetanus and whole cell pertussis (DTwP)‐containing combination vaccines are licensed and used world‐wide. This study assessed the immunogenicity and safety in infants of a combined diphtheria‐tetanus‐whole cell pertussis‐Haemophilus influenzae type b‐CRM197 conjugate full liquid vaccine. Methods: The safety and efficacy of a combined ready‐to‐use liquid vaccine containing diphtheria and tetanus toxoids, cell suspension of Bordetella pertussis and H. influenzae type b‐CRM197 conjugate vaccine (DTwPHib) were assessed in infants eligible for the local Expanded Programme on Immunization (EPI) in Valencia, Spain. The comparative group received separate injections of reference vaccines DTwP + Hib. Results: Local and systemic reactions and adverse events were generally mild and similar in the two groups. DTwPHib elicited anti‐PRP antibody titres ±0.15 μg ml−1 in 97% and DTwP + Hib in 94% of infants. Furthermore, 89% of DTwPHib and 78% of DTwP + Hib recipients attained anti‐PRP antibody titres ±1.0 μg ml−1, signifying long‐term protection. The anti‐PRP geometric mean titre was significantly higher in the combined DTwPHib vaccine group (6.65 vs 3.57 μg ml−1). In both groups, 99% of infants achieved protective (±0.01 IU ml−1) anti‐diphtheria antibody levels and all children achieved protective (±0.1 IU ml−1) anti‐tetanus antibody levels. DTwPHib caused a ±2‐fold increase in anti‐pertactin antibody titres in 91% and a ±4‐fold increase in 82% of recipients. The corresponding proportions in the DTwP + Hib group were 95% and 90%. DTwPHib induced a ±2‐fold increase in anti‐Agg 12 and 3 antibody levels in 79% and a ±4‐fold increase in 73% of recipients. The corresponding proportions among DTwP + Hib infants were 85 and 82%. Conclusion: Overall, the combined liquid vaccine DTwPHib is a safe and effective immunogenic vaccine for EPI use in infants.
The size of the thymus: an important immunological diagnostic tool?
Authors: Jeppesen DL
Published: August 2010

The report on the influence of seasonal factors on thymic size in early life describes a pattern of ultrasonographically measured thymic growth in Gambian infants including the finding of a smaller thymus in the hungry season. These factors raise a number of important questions: Is the size of the thymus relevant to its function and could measurement of the thymus be a useful immunological diagnostic tool in the investigation of thymic function in humans with a depressed immune system?

Conclusion: Studies using the size of the thymus as an immunological diagnostic tool should be encouraged.
Management of children with dilating vesico‐ureteric reflux in Sweden
Authors: Esbjörner E , Hansson S , Jakobsson B ,   on behalf of the Swedish Paediatric Nephrology Association
Published: August 2010

Aim: To evaluate the management and outcome of children with dilating vesico‐ureteric reflux diagnosed before 2 y of age. Methods: This retrospective, multicentre study was part of a programme for quality assurance in Sweden. A total of 2309 unselected children, aged 0–2 y, were investigated after the first urinary tract infection. Voiding cystourethrography was performed in a total of 1953 children, of whom 584 had reflux. Of these children, 303 (119 boys and 184 girls) had reflux with dilatation (grade 3–5). Results: Follow‐up after 4–6 y was reported in 272 of the 303 children. Spontaneous regression of dilating reflux occurred in more than half of the patients and was significantly more frequent in boys than in girls (p= 0.047). In children with grade 3 reflux and grade 4–5 reflux, there were pyelonephritic recurrences in 18% and 45% of the boys and 28% and 70% of the girls, respectively (p < 0.001). One hundred and eighty‐one children (65%) were managed conservatively, 58 (21%) were treated with subureteric injection and 33 (12%) with ureteric reimplantation. There were considerable differences in treatment strategies between centres.

Conclusion: This study of an unselected cohort of children with urinary tract infection and dilating reflux showed spontaneous resolution of dilating reflux in more than half of the subjects and more often in boys than in girls. Pyelonephritic recurrences were more common in girls than in boys, and more frequent in grade 4–5 reflux than in grade 3. The results indicate important differences between the sexes and that boys and girls should be assessed separately when treatment strategies are studied.
Meaningful care for babies born after 22, 23 or 24 weeks
Authors: Greisen G
Published: August 2010

The dilemma of proper treatment of very low‐birthweight infants is discussed.

Conclusion: Professionals should be aware of the data in order to consider the chances of every baby and to engage in the relationship with the family, care team and society.
Procalcitonin serum levels in perinatal bacterial and fungal infection of preterm infants
Authors: Distefano G , Curreri R , Betta P , Romeo MG , Amato M
Published: August 2010

Aim: To determine reference values for procalcitonin (PCT) and C‐reactive protein (CRP) for gestational age and to use these parameters as diagnostic markers of perinatal bacterial and fungal infection. Methods: PCT and CRP serum levels were measured in a case‐control study in a group of 35 low birthweight infants (>34wk of gestation). 27 babies (77%) had clinical signs of infection confirmed by positive blood cultures and were compared to 8 (23%) uninfected matched patients. Seventeen (63%) of them had bacterial infection and 10 (37%) had fungal infection (Candida). Serum PCT (Brahms Diagnostika) and CRP (Immunoassay Vitros 950) were measured serially at 3, 7 and 10 d of life. Results: At any time, PCT and CRP levels were significantly higher in neonates with perinatal infection (p < 0.05) (>0.7 ng ml−1 and >1 mg dl−1, respectively). PCT showed a more rapid response to infection (9.3 ± 1.5 ng ml−1), especially to bacterial infection (10.8 ± 1.4 ng ml−1), than CRP (1.5 ± 0.5 mg dl−1) (sensitivity 99% vs 88%). Lower sensitivity was noted for both parameters, PCT and CRP, to follow babies with fungal infection (6.7 ± 0.8 ng ml−1 and 0.9 ± 0.7 mg dl−1, respectively) (sensitivity 77% vs 58%).

Conclusion: This study gives PCT reference values in preterm babies with perinatal infection. In these babies, PCT seems to be more sensitive than CRP as a diagnostic marker of infection. Both parameters can be used alone or in combination for a better identification and follow‐up of bacterial and fungal infection during the perinatal period.
Bradycardia and hypoxaemia due to position‐dependent hypoperfusion of the brain stem in a preterm infant
Authors: Vogelberg C , Taut‐Sack H , Friebel D , Maier U , Rupprecht E
Published: August 2010

The case is reported of a male baby with a decreased time average velocity of the basilar artery to 32%, measured by Doppler sonography in dextro‐rotated head position. The decrease was due to a hypoplastic right vertebral artery with compression of the contralateral vertebral artery at the craniocervical junction during dextro‐rotation of the head. This finding was more prominent in prone than in supine position. A decrease in oxygen saturation and heart rate to >70% and 60bpm, respectively, was monitored during dextro‐rotation. The polysomnography also revealed postural‐dependent bradycardia, decrease of the oxygen saturation, and rising carbon dioxide partial tension in prone position with dextro‐rotation of the head.

Conclusion: Hypoperfusion of the brain stem caused by postural changes leads to further clinically relevant changes. Therefore an association with an acute life‐threatening event and sudden infant death syndrome is speculated.
Vitamin A for acute respiratory infection in developing countries: a meta‐analysis
Authors: Brown N , Roberts C
Published: August 2010

Aim: To determine the efficacy of intervention with high‐dose vitamin A as an adjunct to standard treatment on outcome in acute lower respiratory tract infection in children in developing countries. Methods: A systematic review of double‐blinded, randomized, controlled intervention studies of high‐dose vitamin A or placebo in children aged between 1 mo and 6 y presenting with acute non‐measles lower respiratory tract infection. Results: Five studies fulfilling the criteria were identified and included a total of 2177 children (1067 intervention, 1110 control). The main outcome measures were time to normalization of fever, respiratory rate and oxygen dependence, time to discharge, and mortality. On meta‐analysis, there were no significant differences in any of the recovery measures or mortality between the intervention and control groups. Pooled results for recovery times are given showing difference in days to recovery days and 95% confidence intervals. Positive summary measures indicate faster recovery in the vitamin A group and negative in the placebo: fever: 0.03 (—0.10 to 0.17); oxygen requirement: —0.08 (—0.31 to 0.16); raised respiratory rate: —0.09 (—0.38 to 0.19); hospital stay: —0.06 (—0.52 to 0.40). Mortality was below 2% in both groups, with a non‐significantly higher risk in the intervention group (odds ratio 1.16, 95% CI: 0.61—2.21).

Conclusion: There is no evidence from this meta‐analysis that intervention with high‐dose vitamin A improves recovery from pneumonia in children in developing countries aged from 1 mo to 6 y.
Gastrointestinal complaints and diagnosis in children: a population‐based study
Authors: Kokkonen J , Haapalahti M , Tikkanen S , Karttunen R , Savilahti E
Published: August 2010

Aim: To find out the extent to which children at 10–11 y of age suffer from various gastrointestinal complaints and how often a food‐induced or other diagnostic disorder might be assessed behind them, we carried out a population‐based survey of 404 children in a rural Finnish town. Methods: A questionnaire filled in retrospectively by their parents was used to describe the frequency of various abdominal symptoms during the previous 2 y and to select the symptomatic subjects for closer clinical examination. In the clinical investigation of the children, an elimination challenge with milk protein and lactose intolerance tests, as well as endoscopic examinations in selected cases and blood tests, were performed. Results: In all, 110 (27%) subjects reported some gastrointestinal (GI) complaints during the last 2 y; 64 (16%) meeting the Apley criteria for recurrent abdominal pain. A specific organic or functional disorder was found in 26 subjects (6%), two having no GI symptoms. Milk protein intolerance was the most common specific disorder diagnosed in nine subjects (2.2%), followed by lactose intolerance in eight (2%), coeliac disease in five (1.2%) and Helicobacter pylori infection in three (0.7%). An endoscopic examination performed on 17 subjects (4.2%) and a colonoscopy on three revealed significant findings in 11; lymphonodular changes being most common, occurring in five subjects. Subjects with milk protein‐induced disorders showed significantly lower IgA‐class antibodies to milk and its fractions than the non‐symptomatic controls. Chronic diseases, short breastfeeding, GI problems and food intolerance during the first year of life were observed as significant risk factors in determining whether a subject belonged to the group experiencing any GI complaints.

Conclusion: We conclude that in one in five of those with any, even mild, GI complaints we were able to assess a specific organic disease; milk‐induced disorders being most common. A milk protein and/or lactose load test, completed in some cases with an endoscopic examination, would help in assessing a proper individual diagnosis.
Effect of joint injections in children with juvenile idiopathic arthritis: evaluation by 3D‐gait analysis
Authors: Broström E , Hagelberg S , Haglund‐Åkerlind Y
Published: August 2010

Aim: To investigate how gait patterns change after intra‐articular corticosteroid injections (ICIs) in the lower extremities. Methods: Eighteen children, aged 5–16 y, with juvenile idiopathic arthritis (JIA) and lower extremity involvement participated in the study. Sixty‐four joints in the lower extremities were treated with ICIs. The Visual Analogue Scale (VAS, 0–100 mm) was used to assess pain. A 3D motion analysis system and two force plates were used to measure gait parameters, kinematics and kinetics. The first gait analysis was performed before treatment with ICIs, and a second one was done 8–17 d after treatment. Results: The participants' average rating of pain decreased from 26 mm on the VAS before ICI to 11 mm (p= 0.001) after treatment. The self‐chosen walking velocity was significantly faster (p= 0.02) after treatment. The range of knee and ankle joint angles during gait increased significantly (p= 0.03 and 0.04) after treatment. At loading response, the hip extension moment increased (p= 0.01) as did knee flexion moment, and plantar flexion moment at pre‐swing increased significantly (p= 0.02 and 0.002) after treatment. The ankle also generated more power (p= 0.005) after treatment.

Conclusion: The study shows positive effects of treatment with ICIs in the lower extremities—especially regarding pain, walking velocity and joint moments. The data indicate that ICI treatment influences the gait pattern also in joints that have not been injected.
The relationship between socio‐economic status and physical activity patterns in South African children
Authors: McVeigh JA , Norris SA , de Wet T
Published: August 2010

Aim: To examine: (1) the associations between socio‐economic status, physical activity, anthropometric and body composition variables in South African children; (2) the influence maternal characteristics have on children's physical activity levels; and (3) associations between television watching, activity level and body composition. Methods: In 381 South African children, physical activity and socio‐economic status were assessed via structured retrospective interview using validated questionnaires. An asset indicator score was calculated as a proxy measure of socio‐economic status and used to divide children into quartiles. Results: Children falling into the highest socio‐economic status quartile had mothers with the highest educational levels, generally came from dual parent homes, were highly physically active, watched less television, weighed more and had greater lean tissue than children in lower quartiles. A greater percentage of children living in dual parent homes and with mothers of a higher educational status were highly active compared with children living in single parent homes and with mothers of a lower educational status. We found greater levels of lean mass with increased activity level after controlling for television watching time and fat mass. There were high levels of low activity and high television watching time among lower socio‐economic status groups. There were significant racial differences in patterns of activity. White children were found to be more active than black children, more likely to participate in physical education classes at school and watched less television than black children.

Conclusion: Physical activity levels and socio‐economic variables are closely related in this population of South African children.
Papillary fibroelastoma of the tricuspid valve presenting as neonatal pulmonary haemorrhage
Authors: Sridhar AV , Bulock F , Hickey MStJ , Chikermane A , Black E , Currie A
Published: August 2010

Papillary fibroelastoma is a benign tumour of the cardiac valve apparatus. We present an unusual case of life‐threatening pulmonary haemorrhage and disseminated intravascular coagulation in a neonate associated with this benign cardiac tumour. Papillary fibroelastoma of the tricuspid valve rarely presents in children and, to our knowledge, this is only the second reported case in a neonate. The patient was successfully managed by anticoagulation therapy followed by surgical excision of the tumour. This case illustrates the potentially fatal presentation of this benign cardiac tumour among neonates.

Conclusion: Pulmonary haemorrhage of this degree is unusual in an otherwise healthy term neonate and needs careful investigation for unusual pathology including potential sources of pulmonary emboli in the heart. We emphasize the value of echocardiography in the evaluation of unexpected pulmonary haemorrhage in the newborn.
Accelerated ventricular rhythm in the neonatal period: a review and two new cases in asymptomatic infants with an apparently normal heart
Authors: Anatoliotaki M , Papagiannis J , Stefanaki S , Koropouli M , Tsilimigaki A
Published: August 2010

Accelerated ventricular rhythm (AVR) was observed in two newborn infants. In the first case, arrhythmia was noted during the foetal period. Both neonates were asymptomatic and had no evidence of cardiac disease. The arrhythmia eventually disappeared when the infants were 4 mo and 24 d old, respectively. AVR in the neonatal period is reviewed in this report and recent information regarding appropriate diagnostic evaluation, differentiation from ventricular tachycardia and treatment is outlined.

Conclusion: Accelerated ventricular rhythm is a benign and self‐limited arrhythmia in the neonatal period. However, it is important to differentiate it from other serious rhythm disorders, mainly ventricular tachycardia, in order to avoid unnecessary and potentially harmful treatment and to relieve parental anxiety.
Oesophageal atresia in premature infants: an analysis of morbidity and mortality over a period of 20 years
Authors: Deurloo JA , Smit BJ , Ekkelkamp S , Aronson DC
Published: August 2010

Aim: To determine the morbidity and mortality of premature infants born with oesophageal atresia (OA) and to evaluate historical changes in morbidity and mortality over time. Methods: Retrospective analysis of morbidity and mortality of all patients admitted for OA, with or without tracheo‐oesophageal fistula, between 1982 and 2002. Results: The study group consisted of 197 consecutive patients, of whom 55 (28%) were premature and 21 (11%) very premature. Type A atresia was found more often in very premature and premature infants than in those born at term (p= 0.02). Type E atresia was not found in the premature group (p= 0.004). At least one associated congenital anomaly was also present in 121 patients (61%). Postoperative complications developed more often in very premature and premature infants than in those born at term (p < 0.001). Gastro‐oesophageal reflux was diagnosed in 32/76 premature infants and in 41/121 term infants (p= 0.001). Mortality among very premature and premature infants was higher than among those born at term (p= 0.003). Withdrawal of treatment was the most frequent cause of death.

Conclusion: Premature infants with OA have a higher morbidity and mortality than term infants with OA. The complications of prematurity contribute significantly to morbidity and mortality in premature infants with OA. There is no reason to refrain from the standard treatment of OA in premature infants with no severe associated congenital anomalies.
T cell receptor V gene usage by CD4+ and CD8+ peripheral blood T lymphocytes in immune thrombocytopenic purpura
Authors: Hedlund‐Treutiger I , Elinder G , Wigzell H , Grunewald J , Wahlström J
Published: August 2010

Aim: To identify T cell expansions, i.e. increased frequencies of T cells using a particular T cell receptor (TCR) Vα or Vβ gene segment, in patients with immune thrombocytopenic purpura (ITP). Methods: The TCR repertoires of CD4+ and CD8+ peripheral blood lymphocytes of 16 patients with chronic ITP were analysed by staining with a panel of anti‐TCR Vα and Vβs antibodies followed by flow cytometry. Results: Four of the 16 patients exhibited a total of 6 expansions of CD8+ T cells using a particular Vβ segment, but no expansions were detected in the CD4+ subset. For three of the expansions where a follow‐up blood sample after treatment with intravenous immunoglobulin was available, only one expansion remained.

Conclusion: Overall T cell expansion frequency was the same as in healthy individuals. However, the presence of expansions that normalized with treatment suggests the presence of specific T cells implicated in the pathogenesis of ITP.
The effect of prenatal consultation with a neonatologist on human milk feeding in preterm infants
Authors: Friedman S , Flidel‐Rimon O , Lavie E , Shinwell ES
Published: August 2010

Objective: To study the effect of prenatal consultation (PC) with a neonatologist on the incidence and duration of human milk feeding (HMF) in preterm infants. Design/methods: A retrospective matched case‐control study was preformed at a perinatal centre. Study infants were preterm infants (23–35 wk) whose mothers had received PC emphasizing the importance of HMF. Control infants were matched by birthweight, gestational age and multiplicity. Results: Each group included 29 mothers and 46 preterm infants. Mean gestational age was 30.1 ± 3 wk in both groups. Mean birthweight was 1329 ± 489 (PC) and 1334 ± 441 g (control). PC infants received HMF for significantly longer, both in the hospital and after discharge (hospital: PC 37 ± 34 d vs control 15 ± 19 d, p = 0.001; discharge PC 60 ± 57d vs control 21 ± 32d; p= 0.0001). No significant difference in neonatal morbidity was detected between the groups.

Conclusions: PC is associated with significantly longer HMF in preterm infants, both in hospital and after discharge.
Inborn errors of metabolism: an update on epidemiology and on neonatal‐onset hyperammonemia
Authors: Deodato F , Boenzi S , Rizzo C , Abeni D , Caviglia S , Picca S , Bartuli A , Dionisi‐Vici C
Published: August 2010

Inborn errors of metabolism (IEM) are a highly heterogeneous group of genetic conditions and represent a relevant cause of morbidity and mortality in the pediatric population. IEM, which are individually rare but collectively numerous, are well‐recognized entities of the generic class of “rare” diseases. Since the first descriptions by Garrod at the beginning of the 20th century, several hundred new disorders have been defined, as new biochemical and molecular diagnostic tools became available. The clinical pictures of single diseases are extremely diverse, ranging from acute life‐threatening manifestations to chronic late‐onset forms, with single or multiorgan involvement. Mental retardation and progressive neurological impairment often characterize the clinical course. One of the principles to prevent high morbidity and mortality rates is early recognition followed by prompt therapeutic intervention. Therefore, a small number of treatable IEM is subject to neonatal mass screening. More recently, an innovative technique, based on tandem mass spectrometry, has expanded the range of neonatal screening to several additional disorders. Owing to the extreme heterogeneity, as well as to the increasing number of new disorders, exhaustive and updated epidemiological data on the overall occurrence of IEM are lacking. A national retrospective study was conducted to define the epidemiological profile of IEM in Italy and to estimate the costs related to the disease burden. Other relevant issues of our investigations focused on creating protocols of treatment for neonatal IEM, and on the development of new methods for the biochemical diagnosis.
Reading the signs of starvation
Authors: Nicholls Dasha
Published: August 2010

Guidelines for managing malnutrition in adolescent eating disorders are based on limited evidence. Swenne and Engström's study explored the relationship between symptoms, signs and weight status in this patient group, towards refining clinical approaches to nutritional assessment in adolescents.

Conclusion: The need to compare findings across studies is crucial for research in nutritional assessment of adolescents.
Medical assessment of adolescent girls with eating disorders: An evaluation of symptoms and signs of starvation
Authors: Swenne Ingemar , Engström Ingemar
Published: August 2010

Aim: To investigate the prevalence of symptoms and signs related to starvation at the initial examination of adolescent girls with eating disorders (ED). Methods: Two hundred and eleven girls with eating disorders recruited for a multicentre research and evaluation programme of six specialist eating disorder services in Sweden have been studied. The presence or absence of 12 symptoms, reported by the patients, and 16 signs, observed by the examiners, were registered and related to body weight. Results: Eleven observed signs—loss of subcutaneous fat, loss of muscle mass, loss of muscular force, dry and scaly skin, brittle nails, dry and brittle hair, lanugo hair, resting pulse <60, systolic blood pressure <110, peripheral hypothermia, and peripheral cyanosis—were related to body weight expressed in standard deviation scores (SDS). When the number of observed signs for each patient was calculated, there was a strong relationship with weight. The odds ratio for having more than two signs was 4.35 (95% CI 2.67–7.04; p=2.8×10−9) for every one‐unit change in weight SDS. Of the symptoms reported by the patients, only three were related to weight. When the number of reported symptoms for each patient was calculated, a relationship with weight was not observed.

Conclusion: In adolescent girls with ED, physical signs observed at medical examination can be related to weight. However, reported symptoms are poorly related to weight and may be influenced by other factors. The finding emphasizes the importance of medical assessment at presentation of patients with ED.