bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of meningitis and bacteraemia due to Streptococcus pneumoniae in The Netherlands
Authors: Spanjaard L , van der Ende A , Rümke H , Dankert J , van Alphen L
Published: August 2010

In The Netherlands, accurate data on the epidemiology of pneumococcal meningitis are available through a clinical microbiology laboratory‐based national surveillance of cerebrospinal fluid isolates. The Netherlands Reference Laboratory for Bacterial Meningitis receives isolates of about 80% of all meningitis cases and about 40% of bacteraemic cases. The incidence of pneumococcal meningitis has increased slowly from 1.0/100000 in 1990 to 1.5/100000 since 1996. The highest age‐specific incidence of meningitis was observed in children <5y of age (8.2/100000 in 1999). Of all isolates, 35% were from children <5 y of age. The number of isolates from non‐meningitis patients with bacteraemia increased considerably since the early 1990s, especially among the elderly. The highest incidence was found in 1996, probably owing to a relatively severe winter. During 1995–1999, pneumococcal meningitis in The Netherlands was caused mainly by serotypes 3, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Of the cases in children <15y, almost half were caused by serotypes 6B, 14, 18C, and 19F. The serotypes present in the 23‐valent polysaccharide and 7‐valent conjugate vaccines accounted for 87% and 47% of all meningitis cases, respectively. Pneumococcal resistance to penicillin in The Netherlands is still low, at about 1%. Genotypically, resistant strains belong to many clones. Horizontal transfer of capsular genes occurs among these isolates. In The Netherlands, 45% of cases of pneumococcal meningitis have severe predisposing factors. The case‐fatality rate was significantly higher among patients with impaired immunity than among those with a break in the integrity of the dura.
Epidemiology of pneumococcal infections in French children
Authors: Gaudelus J , Cohen R , Reinert P
Published: August 2010

Since 1977, resistance to ß‐lactams and other families of antibiotics among isolates of Streptococcus pneumoniae has increased alarmingly worldwide. France is particularly affected by this phenomenon; in 1997 the French National Reference Centre for Pneumococci reported that 44% of S. pneumoniae strains were penicillin non‐susceptible (PNSS). Furthermore, resistance to macrolides (53%) and sulphonamides (37%) was comparable; in addition, >50% of PNSS had a high level of resistance to penicillin and were multiresistant. The highest frequency of resistance is observed in children, particularly those with acute otitis media (AOM).

Conclusion: The clinical consequences of increasing antibiotic resistance are evident for meningitis and AOM, prompting clinicians to consider alternative agents such as high‐dose cefotaxime (300 mg/ kg/d) or ceftriaxone (100mg/kg/d) plus vancomycin (60 mg/kg/d) for meningitis, and high‐dose amoxicillin (>80 mg/kg/d) or ceftriaxone (50 mg/kg/d) for AOM.
Intrauterine growth retardation and brainstem auditory‐evoked response in preterm infants
Authors: Kohelet D , Arbel E , Goldberg M , Arlazzoroff A
Published: August 2010

Intrauterine growth retardation is frequently associated with intrauterine undernutrition, and can deleteriously affect brain function. Twenty‐eight premature small for gestational age infants were compared with 28 premature appropriate for gestational age infants to determine whether intrauterine growth retardation was associated with abnormalities in the auditory pathway in the early neonatal period. The auditory pathway was studied between 4‐18 wk of life by analysis of brainstem auditory‐evoked potentials elicited by a 10/s 75 decibel above normal adult hearing level (dB nHL) click stimulus presented at the infants'ears. Peak latencies of components I, III and V, and interpeak latencies I‐III, III‐V and I‐V, yielded no statistically significant differences between groups. The present study indicates that intrauterine growth‐retarded premature infants may not have abnormalities of brainstem auditory‐evoked response in the early neonatal period.
Unilateral posthaemorrhagic hydrocephalus in the neonatal period or later in infancy
Authors: de Vries LS , Groenendaal F , Gooskens R , Hanlo P
Published: August 2010

Five infants who developed unilateral hydrocephalus associated with antenatal or perinatal intraventricular haemorrhage (IVH) in the neonatal period or later in infancy are reported. Unilateral hydrocephalus occurred following discharge home in four of our five cases, two of whom had been treated during the neonatal period with either serial lumbar punctures or punctures from a Rickham reservoir. An obstruction at the level of the foramen of Monro following a large subependymal matrix bleed appeared to be the underlying aetiology. These data suggest that infants who suffer a predominantly unilateral IVH, with or without parenchymal involvement, can subsequently develop unilateral hydrocephalus. Cranial ultrasound examinations should be repeated at regular intervals during the first year of life, as unilateral hydrocephalus can still develop after a period of apparent stabilization.
Neonatal micrognathia is associated with small upper airways on radiographic measurement
Authors: Gunn TR , Tonkin SL , Hadden W , Davis SL , Gunn AJ
Published: August 2010

In order to determine if infants with clinical micrognathia identified in the newborn period have smaller upper airways than do normal infants, and if their airway size is related to risk of later apnoea, respiration‐timed upper airway radiographic measurements were performed in 21 asymptomatic neonates with clinical micrognathia. Their radiographic measurements were compared with those of a previously reported cohort of 35 normal infants. The micrognathic infants and a control group of 27 infants referred for parental anxiety were followed for 6 mo on home apnoea monitors. Sleep apnoea at home requiring stimulation by the parents occurred in 6 of 7 infants with micrognathia associated with craniofacial anomalies, 9 of 14 (64%) infants with isolated micrognathia, but only 1 of the 27 control infants (p < 0.001). Upper airway measurements at term of the infants with isolated micrognathia who later experienced apnoea were significantly smaller than either those of normal infants (p < 0.01) or of micrognathic infants who did not have apnoea requiring stimulation (p < 0.05). In conclusion, upper airway measurements on timed lateral radiographs in asymptomatic micrognathic infants at term (corrected age) revealed them to be smaller than those of normal infants. Narrower upper airways were associated with increased risk of subsequent apnoea requiring stimulation.
Can severe language disability be identified in three‐year‐olds? Evaluation of a routine screening procedure
Authors: Westerlund M , Sundelin C
Published: August 2010

This study evaluates the predictability of a new language screening procedure in 3‐y‐olds. It is used in several Child Health Centres (CHC) in Sweden and has the character of a field study involving more than 60 CHC nurses. The main questions concern the (i) development in 3‐y‐olds assessed as severely language delayed and (ii) whether there are any earlier unknown severely disabled children identified at 4 y of age. Ninety‐six percent of the original study population participated in the follow‐up. The calculations are based on results from 2237 children. A well‐established screening routine, which has been shown capable of predicting the risk of not being able to follow expected schooling, and case records were used as an acceptable proxy outcome measure, pending a better gold standard. In the group of severely disabled 3‐y‐olds, sensitivity, specificity and positive predictive values were 86, 99 and 43%, respectively. Finally, three false‐negatives were identified. In light of the present results, continued application of the 3‐y screening is discussed.
Long‐term coping in childhood cancer survivors: influence of illness, treatment and demographic background factors
Authors: Boman K , BodegåRrd G
Published: August 2010

In 30 survivors of childhood cancer, long‐term psychological coping with experience of disease and treatment was studied in relation to factors associated with illness, treatment and demographic background. Coping was assessed in a prior study, in which three groups of varying levels of coping where delineated (good, 40%; intermediate, 33%; poor, 27%, coping). The present study showed that poor individual coping was related to diagnosis, a shorter time of continuous complete remission, more severe illness and treatment impairments, and lower scores on a test of intellectual abilities. In addition, a longer time of treatment tended to be followed by poorer coping. However, no association was found for gender, parents' occupational level, age at illness onset, neuro‐cranial irradiation, irradiation dose (total) or age at investigation. A tentative path‐analysis was executed, displaying a model for the relationships between medical and demographic background variables, and for their influence on coping. It was concluded that a complex of factors‐associated particularly with severity of disease and treatment‐appears to be related to, and affects, coping with the illness experience. Patients' long‐term coping with their illness trauma is most likely determined by multiple factors. Intellectual capabilities are related to coping.
Previous breastfeeding does not alter thymic size in infants dying of sudden infant death syndrome
Authors: Thompson JMD , Becroft DMO , Mitchell EA
Published: August 2010

The relationship between thymic weights and previous feeding histories was examined in 294 infants of 37 wk gestation or more dying of sudden infant death syndrome (SIDS). One hundred and sixty‐five infants had been breastfed exclusively, 89 had been partially breastfed and 40 had never been breastfed. We found no relationship between thymic weight and type of previous feeding. The difference between these findings in SIDS and the substantially greater thymic size previously reported in 4‐mo‐old breastfed living infants deserves further study.
Effect of Helicobacter pylori eradication on sideropenic refractory anaemia in adolescent girls with Helicobacter pylori infection
Authors: Choe Yh , Lee Je , Kim Sk
Published: August 2010

We investigated the effect of Helicobacter pylori eradication on sideropenic refractory anaemia in adolescent girls with H. pylori‐associated antral gastritis without evidence of haemorrhage or clinical symptoms other than sideropenic anaemia. We conducted an open therapeutic trial in 21 adolescent girls aged 15–17 y with sideropenic refractory anaemia, which was defined as iron‐deficiency anaemia refractory to oral iron therapy for 3 mo. All subjects underwent gastroduodenal endoscopy. Thirteen patients with confirmed H. pylori infection were given a 2‐wk course of triple therapy and 6 wk of oral ferrous sulfate. We compared the mean levels of haemoglobin and serum ferritin among the “initial sample” (the time when the sampling was done before treatment with oral iron),“before eradication” (the time prior to triple therapy for eradication after subjects had been given oral iron for 3 mo) and “after eradication” (the time when the follow‐up endoscopy was performed) data in 11 subjects in whom H. pylori infection was eradicated. Haemoglobin levels (g/dl) were 8.6 ±1.9, 8.6 ±1.4 and 11.3 ±2.3, respectively. Serum ferritin levels (p.g/l) were 4.6 ± 2.4, 4.2 ± 2.3 and 17.5 ± 6.7, respectively. After eradication of H. pylori, mean levels of haemoglobin (p = 0.0002) and serum ferritin (p = 0.0002) showed a prominent increase between “before eradication” and “after eradication”. In conclusion, adolescent girls with sideropenic refractory anaemia should be evaluated for H. pylori infection. If H. pylori infection is coexistent, its eradication along with iron supplementation could correct the anaemia.
Fatty acid composition of plasma lipids in HIV‐infected children. Comparison with seroreverters
Authors: Agostoni C , Riva E , Esposito S , Ferraris G , Principi N , Zuccotti GV
Published: August 2010

Children infected with the type‐1 human immunodeficiency virus (HIV) are at risk of nutritional deficiencies leading to an impaired polyunsaturated fatty acid (PUFA) status. The aim of the present study was to compare the PUFA composition of plasma lipid classes (total lipids, phospholipids (PL), cholesteryl esters (CE) and triglycerides) in well‐growing HIV‐infected children with an age‐matched group of HIV‐seroreverter children born to infected mothers. Eighteen HIV children, of both sexes, mean age 4.6 y, most of whom under combined antiretroviral regimen, were compared with 18 seroreverters, mean age 5.4 y, comparable for demographic, anthropometric and dietary characteristics. All children had adequate growth parameters (weight and height>3rd percentile). The plasma fatty acid content was similar in the two groups. HIV seropositive subjects showed lower linoleic acid (LA) levels in all the plasma lipid fractions, with higher 20:3n‐9 and 20:5n‐3 levels in PL and CE. The plasma PL triene/ tetraene ratio (marker of relative LA deficiency) related positively to the viral load and negatively to the blood CD4+ lymphocyte count. Compared to age‐matched seroreverter subjects, HIV‐seropositive children show a lipid fatty acid status suggestive of relative LA deficiency and increased turnover of the PUFA series.
Long‐term outcome of classical 21‐hydroxylase deficiency: diagnosis, complications and quality of life
Authors: Jääskeläinen J , Voutilainen R
Published: August 2010

A nationwide search of patients with classical 21‐hydroxylase deficiency (21‐OHD) was performed in Finland to determine the long‐term outcome of the disease. In total, 108 patients were found. Fifty‐four patients (50%, 31F, 23M) had deficiency of a salt‐wasting form and another 54 (50%, 29F, 25M) had a simple virilizing form of 21‐OHD. A significant number of severe complications suggestive of glucocorticoid deficiency was found. There were five deaths (4.6% of all) possibly connected with cortisol deficiency. Ten additional patients (9.3% of all) had been acutely admitted 14 times in all due to symptoms of glucocorticoid deficiency. These symptoms included sudden loss of consciousness, convulsions and severe fatigue. Afterwards, permanent neurological defects were detected in two of these patients. Finally, a cross‐sectional study was carried out to establish an estimate of the long‐term outcome of the disease. Thirty‐two (55%) of the 58 patients aged 16 y or more participated in this study. The patient group did not differ from the general Finnish population in terms of education. Three of the patients (5%) had retired prematurely. Surprisingly, the patients felt that their health‐related quality of life, as reported in the RAND‐36 questionnaire, was better than that of the general Finnish population (p= 0.023). However, as a significant number of all patients did not participate in this study, the quality of life evaluation results must be interpreted with caution. In conclusion, a significant number of complications was found among patients treated for classical 21‐OHD. Nevertheless, the disease has a favourable outcome in terms of quality of life.
Utility of brainstem auditory evoked potentials in children with spastic cerebral palsy
Authors: Zafetriou DI , Andreou A , Karasavidou K
Published: August 2010

In a retrospective study of 75 children with spastic cerebral palsy (CP), brainstem auditory evoked potentials (BAEP) were recorded and subsequently correlated with birthweight, gestational age, aetiology and type of CP, neuroradiological findings, additional impairments and disabilities (including the inability to walk independently). Seventeen patients (22.7%) had abnormal BAEP recordings. Thirteen of these 17 patients (76.5%) had spastic tetraplegia, 16 patients (94.1%) were full‐term infants, 12 patients (70.6%) had myoskeletal problems, 9 (52.9%) had epilepsy, 16 (94.1%) had visual impairment, 13 patients (76.5%) were unable to walk independently, while all 17 patients (100%) had speech impairment and mental retardation. The aetiology of CP was prenatal in 2 of these 17 patients (11.8%) and perinatal in 15 patients (88.2%). Thirteen patients (76.5%) had cortical atrophy determined by either computed tomography or magnetic resonance imaging, two patients (11.8%) had an infarct picture and two patients (11.8%) had maldevelopment of the central nervous system. There was a definite statistically significant association between abnormal BAEP recordings and full‐term delivery, perinatal aetiology of CP, spastic tetraplegia, speech, visual and myoskeletal impairments, epilepsy, mental retardation, inability to walk independently and cortical atrophy on neuroimaging (p < 0.001). We conclude that abnormal BAEP recordings in children with spastic CP are indicative of poor prognosis and associated with a “multihandicap state”. BAEP testing should be incorporated into the diagnostic plan of all children with spastic CP newly referred to neurodevelopmental centres.
Intensive nursing care of kwashiorkor in Malawi
Authors: Manary MJ , Brewster DR
Published: August 2010

The case fatality rate for children with kwashiorkor in central hospitals in Malawi was 30.5% (275/901) in 1995. The purpose of this study was to determine whether improved case management with intensive nursing care could lower this case fatality rate. A total of 75 children admitted with kwashiorkor in Blantyre, Malawi, received intensive nursing care. This included nursing in individual clean beds with blankets, a nurse:child ratio of 1:3, supervised feedings every 2 h, a paediatrician with expertise in treating kwashiorkor always available for consultation, laboratory evaluation for systemic infection and empiric use of ceftriaxone. Nineteen of these children died (25%). The causes of death were life threatening electrolyte abnormalities (hypokalaemia, hyponatraemia, hypophosphataemia) in nine cases, overwhelming infection in eight cases and congestive heart failure in two children. Children infected with the human immunodeficiency virus were more likely to die (9/20), as were children with life threatening electrolyte abnormalities (9/15) and children with more severe wasting. When compared with 225 children treated in the same year at the same institution, who were carefully matched for severity of kwashiorkor, intensive nursing did not improve overall survival.
Living conditions in early infancy in Denmark, Norway and Sweden 1992–95: results from the Nordic Epidemiological SIDS study
Authors: Alm B , Norvenius SG , Wennergren G , Lagercrantz H , Helweg‐Larsen K , Irgens LM ,   on behalf of the Nordic Epidemiological SIDS Study
Published: August 2010

The objective was to study living conditions of infants and their families in Scandinavia in the 1990s and to assess similarities and differences among the three Scandinavian countries. The emphasis is on health and normality rather than on diseases and other deviations from well‐being. The subjects are the 869 controls in the Nordic Epidemiological SIDS study carried out between 1 September 1992 and 31 August 1995 in Norway, Denmark and Sweden. The controls were matched with the 244 SIDS cases for sex, age and maternity hospital. Parents of the SIDS cases and the controls filled in the same questionnaire on family, pregnancy, delivery, the neonatal and the post‐perinatal period. The most striking findings were that 99% of the mothers went to regular maternity controls, 97% to well‐baby clinics and 84% breastfed exclusively. On the other hand, 11% drank alcohol more than once a month during pregnancy and 29% smoked during pregnancy. Compared to official statistics, to the extent they exist, the differences were small. The material contains valuable information on normal infant care in Scandinavia in the 1990s. Living conditions of infants in Scandinavia are similar in the three countries. Differences exist, but only to a small extent.
Sleep problems of school‐aged children: a complementary view
Authors: Paavonen EJ , Aronen ET , Moilanen I , Piha J , Räsänen E , Tamminen T , Almqvist F
Published: August 2010

The aim of this population‐based multicentre study was to evaluate the prevalence rates of sleep problems among 8‐9‐y‐old children. The sample consisted of 5813 Finnish children, making up 10% of the age cohort. Both parents and children provided information. Disturbed sleep was reported by 21.7% of parents. Most of the problems were mild; only 0.3% were serious. Dyssomnias were frequent: 11.1% had difficulties with sleep onset, 7.1% with night waking and 2.3% with waking too early. Multiple sleep problems were present in 9.1% of the children. 17.8% of children reported disturbed sleep, 12.7% had problems many nights and 5.1% every night. In 32.0% of cases, either the parent or the child reported disturbed sleep; 7.4% of these reports came from both the parent and the child, 14.1% from the parent only and 10.3% from the child only. The correspondence between informants was poor (κ= 0.224). Sleeping problems were associated with somatic and psychiatric problems. It is concluded that by restricting questioning to parents only, one‐third of all potential cases of sleep problems may go unnoticed. In order to increase the sensitivity of screening children's sleep problems, both parents and children should provide information in epidemiological settings as well as in clinical work.
Self‐esteem, depression and anxiety among Swedish children and adolescents on and off cancer treatment
Authors: Von Essen L , Enskär K , Kreuger A , Larsson B , Sjödén PO
Published: August 2010

Self‐esteem, depression and anxiety were investigated in 51 Swedish children and adolescents, 8‐18y, on (n=16) and off (n= 35) cancer treatment. The self‐report measures “I Think I Am” (ITIA), the Children's Depression Inventory (CDI) and the Revised Children's Manifest Anxiety Scale (RCMAS) were used. Data were compared with data previously obtained by others for healthy Swedish children. Children and adolescents on treatment showed levels of self‐esteem, depression and anxiety comparable to those of healthy children. However, children and adolescents off treatment reported higher depression and anxiety levels and lower psychological well‐being and physical self‐esteem than have been reported for healthy Swedish children. Seven children (14%) reported a high level of depression, six of whom were off treatment. The findings suggest that the period after treatment termination is characterized by a higher risk of psychosocial problems than is the actual treatment period.
Intraepithelial lymphocytes and coeliac disease: permanent changes in CD3−/CD7+ and T cell receptor γβ subsets studied by flow cytometry
Authors: Camarero C , Eiras P , Asensio A , Leon F , Olivares F , Escobar H , Roy G
Published: August 2010

Permanent changes in intestinal intraepithelial lymphocytes have been observed in coeliac patients. The aim of this investigation was to study small intestinal intraepithelial lymphocytes by using flow cytometry and to evaluate its diagnostic value in coeliac disease. Three‐colour flow cytometry analyses were performed on isolated epithelial cells of 117 intestinal biopsies obtained from 113 children (54 coeliac disease, 4 other enteropathies, 18 Helicobacter pylori associated gastritis and 37 normal controls). A multiple logistic regression model was developed to select the best intraepithelial lymphocytes subset predictor of coeliac disease. Coeliac patients had significant higher levels of T cell receptor yS intraepithelial lymphocytes than control patients (p < 0.01), H. pylori patients (p < 0.01) and other enteropathies (p < 0.05). The density of CD3∼/CD7+ intraepithelial lymphocytes, a intraepithelial lymphocyte subset poorly characterized by immuno‐histochemical methods, was significantly lower in coeliac patients than in the control group (p < 0.01), H. pylori group (p < 0.01) and other enteropathies (p < 0.01). Both changes remained altered independent of the coeliac patient's diet. The data were used on a logistic regression analysis in order to calculate sensitivity [94.4%; 95% confidence interval (CI) 83.7‐98.6%], specificity (94.9%; 95% CI 84.9‐98.7%) and likelihood ratio for a positive test 18.5 (95% CI 6.1‐55.8) in the diagnosis of coeliac disease.

Conclusion: Changes in T cell receptor γβ and CD3−/CD7+ intraepithelial lymphocytes subsets are permanently observed in paediatric coeliac disease. Their assessment, by three‐colour flow cytometry on routine diagnostic biopsies, permits a better characterization of coeliac enteropathy and represents a valuable procedure to identify coeliac patients with different clinical presentations.
Deficits in attention, motor control and perception (DAMP): a simplified school entry examination
Authors: Landgren M , Kjellman B , Gillberg C
Published: August 2010

Objective: To suggest an empirically based school entry screening examination for the detection of deficits in attention, motor control and perception (DAMP) in 6‐y‐old children. Material and methods: A population‐based cohort of 113 children, 6‐7 y of age (62 with and 51 without DAMP), compared on measures of attention, motor functions, language and cognition. Results: Attention deficits were convincingly identified by both parents and paediatrician. The motor function tests clearly distinguished between the two groups. Linguistic and meta‐linguistic tests demonstrated greater phonological processing difficulties in the DAMP group. The cognitive test revealed an overall lower IQ but no consistent characteristic pattern in the DAMP group.

Conclusions: A simplified paediatric school entry examination test is suggested. Four motor tests (standing on one foot, Fog test, design copying and diadochokinesis) administered by the paediatrician, combined with a brief structured clinical observation and a structured parent interview, identified 80% of children with DAMP–and all those with severe DAMP–as well as a small number of false positives.
Effect of indomethacin on IL‐1β, IL‐6 and TNFα production by mononuclear cells of preterm newborns and adults
Authors: Sirota L , Punsky I , Bessler H
Published: August 2010

The in vitro effect of indomethacin (IM) on the production of interleukin (IL)‐1β, IL‐6 and tumor necrosis factor (TNF)α by cord blood mononuclear cells (CBMC) from preterm newborns was compared to that of peripheral blood MC of adults (PBMC). MC isolated from peripheral blood of adults (PBMC) and cord blood of preterm newborns (CBMC) were incubated without or with lipopolysaccharide (LPS) in the absence or presence of various concentrations of IM. The levels of IL‐1β, IL‐6 and TNFα in the supernatants were tested by ELISA. MC isolated from preterm newborns were less sensitive to the in vitro effect of IM on IL‐1β and TNFα secretion than adult cells. While the spontaneous secretion of IL‐1β and TNFα and the production of TNFα induced by LPS were significantly increased following incubation of adult PBMC with IM, only the spontaneous synthesis of TNFα by CBMC of preterm newborns was affected by this drug. The in vitro production of IL‐6 by MC in the two groups was not affected by the addition of IM.

It is suggested that IM may affect the preterm's immune response. However, the role of the drug in the frequency and severity of infections in the neonatal intensive care unit needs further investigation.
Magnetic resonance imaging at term and neuromotor outcome in preterm infants
Authors: Valkama AM , Päkö ELE , Vainionpää LK , Lanning FP , Ilkko EA , Koivisto ME
Published: August 2010

In order to evaluate the value of neonatal brain magnetic resonance imaging (MRI) for predicting neuromotor outcome in very low birthweight (VLBW) preterm infants, 51 such infants with gestational age <34 wk underwent brain MRI at term age. Myelination, parenchymal lesions (haemorrhage, leukomalacia, infarction, reduction of white matter), parenchymal lesions without subependymal haemorrhage, ventricular/brain ratios and widths of the extracerebral spaces were assessed. The MRI findings were compared with cranial ultrasound (US) performed at term. Infants' neuromotor development was followed up until 18 mo corrected age. Parenchymal lesions seen in MRI at term predicted cerebral palsy (CP) with 100% sensitivity and 79% specificity, the corresponding figures for US being 67% and 85%, respectively.

Parenchymal lesions in MRI, excluding subependymal haemorrhages, predicted CP with a sensitivity of 82% and a specificity of 97%, the corresponding figures for US being 58% and 100%, respectively. Delayed myelination, ventricular/brain ratios and widths of the extracerebral spaces failed to predict CP. Term age is a good time for neuroradiological examinations in prematurely born high‐risk infants. Parenchymal lesions seen in MRI are reliable predictors for CP.
Unnecessary water supplementation for babies: grandmothers blame clinics
Authors: Almroth S , Mohale M , Latham MC
Published: August 2010

This study was designed to obtain policy‐and programme‐relevant data on exclusive breastfeeding in Lesotho at a time when global recommendations for exclusive breastfeeding were new. During both phases of field research, conducted in 1991 and 1992, qualitative information was obtained through focus groups and individual interviews with mothers, grandmothers and nurses. This was complemented during the second phase with quantitative data collected through a clinic‐based survey of mothers. The qualitative and the quantitative findings consistently converged, illustrating a culture of infant feeding in which breastfeeding was central, but exclusive breastfeeding was an unknown concept and not practised. Grandmothers seemed to be more in tune with the ideal of exclusive breastfeeding as they had given their young infants thin gruel only occasionally. Contemporary mothers, in contrast, were regularly giving their young infants water. Mothers and grandmothers frequently cited nurses as the source of advice for giving water. Grandmothers were adamant in pointing out that they had never given water to their own young infants and asserted that they avoided giving it to their grandchildren as they considered it unnecessary and harmful. According to the grandmothers, water supplementation was a new practice that had been introduced through the clinics.

Conclusion: Efforts to discourage water supplementation and encourage exclusive breastfeeding in this setting need to be directed both at mothers and health providers.
Elevated serum creatinine levels in infants with congenital hypothyroidism: reflection of decreased renal function?
Authors: Asami T , Uchiyama M
Published: August 2010

The effects of hypothyroid status on renal function have been poorly studied in children. We assessed the renal function of hypothyroid infants detected during neonatal mass screening for congenital hypothyroidism (CH). Eighty hypothyroid infants and 20 age‐matched normal infants for controls were enrolled. The 80 patients, aged 1 mo, were divided into two groups based on the initial thyroid stimulating hormone (TSH) and free thyroxine (FT4) values: a mild‐moderately hypothyroid (MHT) group (n= 64, 31M and 33F) and a severely hypothyroid (SHT) group (n= 16, 3M and 13F). Serum creatinine (SCr), TSH, FT4 and other chemicals were compared before and 2 mo after L‐thyroxine (LT4) substitution therapy. The following results were obtained: SCr levels were significantly higher in the SHT group (33.2 ± 10.0 mol/L, p < 0.001) compared with the MHT group (20.6 ± 6.4 mol/L) and normal control group (21.0 ± 4.4 mol/L). Two months after the LT4 replacement therapy, the elevated SCr levels in the SHT group decreased by 41.3% to the level (19.5 ± 6.0 mol/L) very close to that in the MHT group (18.8 ± 5.1 mol/L). No significant differences were noted among BUN levels in the three groups. Although serum creatinine kinase levels were significantly higher in the SHT group (230.3 ± 102.3 U/L, p < 0.001) than in the MHT group (121.1 ± 60.8 U/L), rhabdomyolysis was not considered to be responsible for the impaired renal function.

Conclusion: From these results we conclude that serum creatinine levels are elevated in congenitally hypothyroid infants. This is a reversible change with thyroid hormone replacement therapy. The possibility of impaired renal functions should be kept in mind when treating hypothyroid infants.
Budesonide delivered by dosimetric jet nebulization to preterm very low birthweight infants at high risk for development of chronic lung disease
Authors: Jónsson B , Eriksson M , Söder O , Broberger U , Lagercrantz H
Published: August 2010

We investigated the effect of an aerosolized corticosteroid (budesonide) on the oxygen requirement of infants at high risk for developing chronic lung disease (CLD) in a randomized, double‐blind study. The study objective was to attain a 30% decrease in FiO2 levels in the budesonide treatment group after 14 d of therapy. Thirty very low birthweight (VLBW) infants (median (range)) gestational age 26 wk (23–29) and birthweight 805 g (525–1227) were randomized. Inclusion criteria were mechanical ventilation on day 6 of life, or if extubated on nasal continuous positive airway pressure with FiO2± 0.3. The budesonide (Pulmicort™ dose was 500 μg bid, or placebo. The aerosol was delivered with a dosimetric jet nebulizer, with variable inspiratory time and breath sensitivity. Inhalations were started on day 7 of life. Twenty‐seven patients completed the study. A significant lowering of the FiO2 levels at 21 d of life was not detected. Infants who received budesonide were more often extubated during the study period (7/8 vs 2/9) and had a greater relative change from baseline in their oxygenation index (budesonide decreased 26% vs placebo increased 60%). Subsequent use of intravenous dexamethasone or inhaled budesonide in the treatment group was significantly less. All patients required O2 supplementation on day 28 of life. At 36 wk postconceptual age, 61% of infants in the budesonide group needed supplemental O2 as opposed to 79% in the placebo group. No side effects on growth or adrenal function were observed

Conclusion: We conclude that inhaled budesonide aerosol via dosimetric jet nebulizer started on day 7 of life for infants at high risk for developing CLD decreases the need for mechanical ventilation similar to intravenous dexamethasone, but without significant side effects.
Influence of the initial management regimen and family social situation on glycemic control and medical care in children with type I diabetes mellitus
Authors: Forsander GA , Sundelin J , Persson B
Published: August 2010

It is well known that social family factors are of importance in diabetes care, but it is not clear whether the initial management regimen can buffer these factors. In a prospective, randomized intervention study, 36 children with diabetes mellitus (type I) were followed, the aim being to study if a family psychosocial intervention at diagnosis could improve glycemic control and minimize hospital admissions. The control group was treated initially in a hospital ward, while the study group received problem‐based learning and family‐therapeutic and social support in an out‐hospital training apartment. A number of family social variables were evaluated at the time of diagnosis and 6, 12 and 24 mo later. Family function was assessed using the self‐estimated Family Climate Test at these same time‐points. HbA1c values and information concerning in‐ and out‐hospital visits to the pediatric clinic were collected for the 5‐y period following diagnosis. We found no association between the offered management regimen and glycemic control or rate of readmission. In the study group only, both parents reported a significant improvement of the family climate. An increased risk for poor glycemic control was recorded in children living in one‐parent families (p= 0.03) or in families where the father had a low level of education (p= 0.04). Younger age (p= 0.05), a single‐parent family (p= 0.05) and poor glycemic control (p= 0.02) were associated with more days of rehospitalization. The rate of divorce in the whole group was at least as high as in the normal population but, surprisingly, maternal dysfunction was associated with lower HbA1c value.

The conclusion is that even with an initial management regimen designed to offer a family‐individual care regimen based on accurate estimation of the psychological and pedagogical needs, the social family background is a most important factor for the glycemic control and need for readmission.
Children of mothers abusing amphetamine: head circumference during infancy and psychosocial development until 14 years of age
Authors: Eriksson M , Jonsson B , Zetterström R
Published: August 2010

Objective: To study the relationship between head circumference (HC) at birth (HO) and at 1 y of age (HI) and later outcome variables in children exposed to amphetamine during fetal life through maternal drug abuse. Method: Prospective longitudinal study of 65 children born to women abusing amphetamine. Potential bivariate and partial correlations between HC and outcome variables at 4, 8 and 14 y of age were studied. In multivariate analyses on outcome variables, HC, maternal and perinatal factors were used as predictors. Analyses were performed for all children and separately for boys and girls. Results: Head circumference at birth and 1 y of age were significant predictors for the level of achievement in Swedish language at 14 y. Head circumference at birth was a significant predictor for grades in mathematics in boys. Combined assessment of psychomotor development and psychosocial adjustment at 4 and 8 y correlated with HI in girls.

Conclusion: Head circumference at birth and at 1 y of age correlated with school achievement at 14 y. HI also correlated with adjustment at 4 and 8 y in girls. A difference in vulnerability between girls and boys is important and should be considered in longitudinal studies of risk cohorts.
Clinical features, laboratory findings and differential diagnosis of benign acute childhood myositis
Authors: Zafeiriou DI , Katzos G , Gombakis N , Kontopoulos EE , Tsantali C
Published: August 2010

We report clinical and laboratory data from 32 children with benign acute childhood myositis (BACM), children who presented with calf tenderness and gait abnormality. Laboratory evidence of a viral infection was evident in 23 patients, while serum creatine phosphokinase was uniformly increased (558 to 6800 U/L). Twenty‐five patients (78.1%) were given a diagnosis other than BACM by their general practitioner or paediatrician. All patients made a rapid recovery within one week.

We conclude that BACM should be encountered among the main causes of sudden‐onset gait abnormality in young children.
Acyclovir‐resistant varicella infection with atypical lesions in a non‐HIV leukemic infant
Authors: Crassard N , Souillet AL , Morfin F , Thouvenot D , Claudy A , Bertrand Y
Published: August 2010

An HIV‐negative infant presented with VZV primary infection during the maintenance therapy for mega‐karyoblastic leukaemia. The lesions were initially vesicular and necrotic but became verrucous and hyperkerato tic. A clinical resistance to acyclovir was suspected and confirmed by histologic and virologic studies. The patient was successfully treated by foscarnet. Conclusion: resistance of VZV to acyclovir may occur after a short treatment in a non‐AIDS patient. ± Acute leukaemia, acyclovir, foscarnet, Varicella zoster virus
Early identification of children with developmental disabilities
Authors: Sonnander K
Published: August 2010

This paper provides an overview of research into early identification of children with developmental disabilities in child healthcare, especially those disabilities related to cognitive impairment. The review covers the following related topics: definition of the target group, the predictive value of developmental screening instruments and psychomotor tests, risk indexes, early intervention and evaluation of developmental screening programmes. Empirical research into child development and the predictive value of developmental tests is extensive. However, proportionally few, mostly cohort or case‐control, studies focusing on evaluation of developmental screening programmes conducted within a clinical setting were found. Some sensitivity and most specificity rates reported fell within what is considered acceptable for developmental screening performed in the pre‐school years, i.e. a sensitivity of more than 70% and a specificity between 70% and 80%. Overall, between 1–6% of the children screened were identified.

Typically, most children with severe disabilities were identified prior to the screening or excluded from the studies reviewed. The shortcomings of developmental screening (instruments) and difficulties in early identification are discussed.
The role of the Child Health Services in the identification of children with possible Attention Deficit Hyperactivity Disorder/Deficits in Attention, Motor Control and Perception (ADHD/DAMP)
Authors: Blomquist HK
Published: August 2010

Literature concerning the role of the Child Health Services in the identification of children with possible Attention Deficit Hyperactivity Disorder/Deficits in Attention, Motor Control and Perception (ADHD/DAMP) is summarized in order to establish a background for evaluation, discussion and conclusion.
Secondary prevention in child health: effects of psychological intervention, particularly home visitation, on children's development and other outcome variables
Authors: Lagerberg D
Published: August 2010

This paper reviews interventions targeting socially deprived families, families with low birth‐weight/premature children, and some other problems (child abuse, sensitivity/attachment, postnatal depression). Conclusions are mainly based on randomized controlled trials. Earlier reviews in the field have emphasized the importance of intensive, enduring home visitation and of early education programmes for young children. Home visitation may positively effect several outcomes, including health behaviour, child safety and stimulation. Rates of child abuse and neglect have proven difficult to influence, but home visitation may result in other gains such as fewer accidents and serious injuries, and greater home safety. The cognitive development of low birthweight and premature children may be positively influenced by home visitation, particularly in combination with an early stimulation programme in the neonatal unit and pre‐school placement. Postnatally depressed mothers have been shown to improve substantially from nurse counselling once a week for 6–8 wk.

It is suggested that home visitation should be tried on a systematic basis, and that early pre‐school experiences should be offered to children in different risk situations. Child Health Centres should introduce a screening programme for postnatal depression. Specialist child health units should be encouraged.
Is prevention of allergy and asthma possible?
Authors: Foucard T
Published: August 2010

Allergy and asthma are common diseases today. Ways to stop the ongoing increase in incidence of these diseases are highly desired. In this review the scientific basis for allergy and asthma prevention is discussed. Results: Although secondary preventive measures are generally regarded as important, the views regarding the possibility of primary prevention vary. There is today only weak evidence that breastfeeding may reduce the risk of developing allergy, and if it does the effect is limited in degree and duration. There is some evidence that prolonged breastfeeding reduces the risk of developing asthma, at least in allergy‐risk infants. There is also some evidence indicating that withholding solid foods in children at risk may have a beneficial effect. A dose‐dependent risk of becoming sensitized to house dust mite and pet animal allergens has clearly been shown, but to what extent this sensitization is combined with asthma or clinical allergy is less well elucidated. Passive smoking increases the risk of wheezing problems and the indoor environment in damp houses seems to act synergistically with passive smoke.

Conclusion: Primary prevention is rarely possible, but the risk of developing asthma and allergy may to some extent be reduced by taking certain measures, such as avoidance of tobacco smoke and damp houses. Breastfeeding seems to reduce the risk of wheezing, but as allergy‐preventive measures, breastfeeding and avoiding pet animals have only marginal effects.
Sedation and monitoring of paediatric patients undergoing open low‐field MRI
Authors: Rupprecht T , Kuth R , Böwing B , Gerling S , Wagner M , Rascher W
Published: August 2010

The purpose of this study was to determine the need, effectiveness and safety of sedation and monitoring in infants and children in a paediatric open low‐field MRI system. Of 274 patients (median age 9 y) examined, only 74 children (median age 25 mo) needed sedation. Sedation was achieved by intravenous administration of midazolam (0.2 mg/kg) and etomidate (0.2 mg/kg). Mean total doses required were 0.28 and 0.27 mg/kg, respectively. With the exception of eight primarily ventilated patients, all children breathed spontaneously. 02 saturation, arterial blood pressure and ECG were monitored. The low resonance frequency of the MRI system required a specially designed high frequency (HF) shielding of the monitor system to avoid HF artifacts. The overall sedation rate was markedly lower (74/274 = 27%) compared to a control group previously examined in a closed high‐field MRI system (52/111 =47%). This was due to a significant lower need for sedation in patients aged up to 10 y (p≤ 0.0001) in the open MRI unit. General anaesthesia could be avoided in all patients. No significant movement artifacts occurred in any of the MRI examinations and no serious side effects were observed.

Conclusions: MRI of children is easier in an open MRI system and with fewer sedations, as in closed high‐field systems. Sedation by a combination of midazolam and etomidate is highly effective and safe. Monitoring devices for high‐field systems may have to be modified for low‐field systems. An in‐hose paediatric MRI unit with an open and special paediatric design is of major advantage for imaging pediatric patients.
The birth process initiates an acute phase reaction in the fetus‐newborn infant
Authors: Marchini G , Berggren V , Djilali‐Merzoug R , Hansson L‐O
Published: August 2010

Our goal was to investigate whether the normal birth process stimulated an acute phase response in healthy infants with physiological changes in the circulating levels of acute phase cytokines and acute phase proteins. We also monitored body temperature, body weight and behavioural state in order to investigate if clinical signs of acute phase reaction were present. We made cross‐sectional measurements of interleukin‐1β, interleukin‐6, C‐reactive protein, serum amyloid A, procalcitonin, prealbumin, body weight, body temperature and the duration of the sleeping period during the first four postnatal days. We found an increase in interleukin‐6 (p < 0.001) during the first day, followed by an increase in C‐reactive protein, serum amyloid A and procalcitonin on the second postnatal day (p < 0.01). The level of prealbumin fell after birth and reached its lowest value at 3 d of age (p < 0,001). Interleukin‐l p remained unchanged. The duration of the sleeping period was longer during the first day (p < 0.01). There was an increase in body temperature during the first day (p < 0.01). Maximal weight loss was during the first 2 d.

Conclusions: The normal birth process and extra‐uterine adaptation stimulates an acute phase reaction in the newborn infant with a release of interleukin‐6 and acute phase proteins and a depression of prealbumin. This reaction, as the body's first line inflammatory defence system, probably affects the infant's behaviour, nutritional state as well as the regulation of body temperature.