bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin‐like growth factor binding protein‐1 as glucose regulator in adolescent boys with type 1 diabetes
Authors: Zachrisson I , Dahlquist G , Wallensteen M , Brismar K
Published: August 2010

The aim of the present study was to investigate whether the diurnal variability of B‐Glucose is dependent on GH, IGF‐I and IGFBP‐I levels, apart from insulin, and if there is any difference between Tanner stages 3 and 5. Five boys in Tanner stage 3 and 6 boys in stage 5 with type 1 diabetes were included. Blood was continuously collected from a cubital vein for 24 h. S‐Insulin, S‐GH, S‐IGF‐I and S‐IGFBP‐1 were analysed. B‐Glucose was analysed hourly at bedside. One week before and 1 wk after the 24‐h study period the participants performed self‐monitoring of blood glucose (SMBG) during normal physiologic conditions. In the 24‐h profile of B‐Glucose, insulin, IGFBP‐I and GH, we found a significant positive correlation between B‐Glucose and log IGFBP‐1 (r=0.5, p= 0.005) and an inverse correlation to insulin (r=‐0.5, p= 0.004) but no correlation to logGH (r=‐0.04, p= 0.831). In multiple regression analysis, B‐Glucose was still significantly correlated to log IGFBP‐1, when adjusting for insulin and GH, in Tanner stage 5. We found a difference between Tanner stages 3 and 5 in the variability of B‐Glucose over a longer period during normal daily activity (p= 0.02), but not over the 24‐h study period.

Conclusion: We have demonstrated in type 1 diabetes adolescent boys a relationship between simultaneously measured blood‐glucose and IGFBP‐1 levels independent of the insulin and GH levels, suggesting that the free fraction of IGF‐I influences the glucose metabolism.
Middle ear effusion IL‐6 concentration in bacterial and non‐bacterial acute otitis media
Authors: Barzilai A , Dekel B , Dagan R , Leibovit E
Published: August 2010

Background: The pathogenesis of acute otitis media is complex and multifactorial. It is characterized by inflammation of the middle ear with an infiltration of leukocytes, macrophages and mast cells. The resulting effusion contains a large amount of inflammatory mediators, among which are cytokines. Objectives: To test the role of IL‐6 in the inflammatory process associated with acute otitis media. Methods: We analyzed 20 middle ear fluid (MEF) sample pairs, obtained by aspiration before initiating antibiotic therapy (day 1) and during treatment (days 4–3, for the presence of IL‐6. IL‐6 concentrations were assayed with an ELISA kit (detection limit 5 pg/ml) and were correlated with bacterial etiology and bacterial eradication from the middle ear. Results: IL‐6 was detected in all middle ear effusions analyzed. We found decreased IL‐6 concentrations in culture negative MEF compared to culture positive MEF on both days 1 and 4–5 (day 1, 1752.20 ± 1001.31 pg/ml vs 1216.20 ± 1015.44 pg/ml, p= 0.19; days 4–5, 1049.36 ± 472.40 pg/ml vs 800.33 ± 676.00 pg/ml, p= 0.23); however, differences did not achieve statistical significance. Overall, a marked and significant decrease in IL‐6 concentration occurred following 72–96 h of antibiotic therapy (1618.15 ± 1004.88 pg/ml vs 936.85 ± 581.05 pg/ml, p= 0.04). While MEF IL‐6 concentrations decreased in ears where bacteria persisted (1468.20 ± 858.48 pg/ml vs 1044.80 ± 514.16 pg/ml, p= 0.167) or were eradicated (2320.20 ± 866.16 pg/ml vs 767.40 ± 522.88 pg/ml, p= 0.029), a more prominent decline was demonstrated in the latter.

Conclusions: These results strongly suggest the involvement of IL‐6 in the ongoing inflammatory process in both bacterial and non‐bacterial acute otitis media. Resolution of inflammation in the middle ear, especially where bacteria were eradicated, is reflected by low IL‐6 levels.
Growth hormone in short children: beyond medicine?
Authors: Bolt LLE , Mul D
Published: August 2010

The indications for growth hormone (GH) treatment in non‐GH‐deficient short children are in debate, with some arguing that this treatment does not belong solely in the medical domain. We describe three different approaches to the issue, and argue that neither a disease‐oriented nor client‐oriented approach is sufficient. Both lead to withdrawal of medical interventions or to an undesirable application.

Conclusion: An approach focusing on suffering as an indication for treatment of short stature is the most appropriate. The challenge is to develop proper tools by which to evaluate suffering and the efficacy of GH treatment in these children in order to relieve or prevent suffering.
Chlamydia pneumoniae in children undergoing adenoidectomy
Authors: Normann E , Gnarpe J , Nääs J , Gnarpe H , Karlsson MG , Wettergren B
Published: August 2010

Chlamydia pneumoniae is a common respiratory pathogen which is often found in paediatric populations. Little is known about the true colonization rate and the localization of the bacteria in the respiratory tract. In this study, immunohistochemistry was used to examine adenoids from 69 children undergoing elective adenoidectomy. Throat swabs for polymerase chain reaction (PCR) and blood samples for serology were also obtained. Chlamydia pneumoniae was demonstrated in the adenoids by immunohistochemistry in 68 of the children. Five children (7%) had a positive C. pneumoniae PCR test from throat swabs and 14 children (20%) had detectable antibodies by the microimmunofluorescence technique.

Conclusion: The results suggest that C pneumoniae is a common finding in the adenoids of children undergoing adenoidectomy. Whether or not C pneumoniae plays a pathogenic role in this patient population could not be determined from the data obtained in this investigation.
Comparison of handling and acceptability of two spacer devices in young children with asthma
Authors: Brand PLP , van der Baan‐Slootweg OH , Heynens JWCM , Vries TW de , Versteegh FGA , Vreuls RCFM , den Ouden WJ , Smit FJ
Published: August 2010

This study compared parents' preference for two spacer devices, NebuChamber® and Babyhaler® for the treatment of young children with asthma. In this open, cross‐over study 141 patients (aged 5–57 mo) who used inhaled steroids via a spacer device were randomized to budesonide via NebuChamber or beclomethasone dipropionate via Babyhaler. Both treatments were given by the parents twice daily for 2 wk. At the final visit parents completed a questionnaire on preference in general and for a given set of features. Acceptability and handling were scored in a diary. Diary scores on acceptability by the child and handling of both spacer devices were comparable. In the preference questionnaire, 68% of parents preferred NebuChamber [95% confidence interval (CI) 60–76] and 25% Babyhaler (95% CI 18–33). The preference was independent of the type of spacer used before the study and was also apparent in the different features: acceptability by child, carrying around, cleaning, close fitting of face mask, assembling and disassembling, damage resistance and size. These differences were statistically significant for all features, except for acceptability by the child.

Conclusion: Two‐thirds of parents prefer NebuChamber over Babyhaler for the treatment of their young asthmatic children.
Comparison of EMLA cream versus placebo in children receiving distraction therapy for venepuncture
Authors: Lal MK , McClelland J , Phillips J , Taub NA , Beattie RM
Published: August 2010

Eutectic mixture of local anaesthetics (EMLA) cream is used routinely as a local anaesthetic prior to venepuncture in children. Despite this, however, a significant proportion of children will still be distressed. Cognitive‐behavioural interventions, such as distraction by breathing and blowing exercises, have been used and found to be helpful as alternative coping strategies. There is, however, a paucity of data regarding effectiveness. We have evaluated the efficacy of distraction therapy as a coping strategy before and during venepuncture, and in these children evaluated the need for EMLA using a prospective, randomized, double‐blind, placebo‐controlled clinical trial. Twenty‐eight children attending for venepuncture were recruited, median age 6 y (range 4–8 y), and randomly allocated to receive either EMLA or a placebo cream. All were given distraction therapy prior to and during the procedure by a play specialist. Venepuncture was carried out by one investigator. A modified pediatric pain assessment chart was used for objective pain score at the end of the procedure. After one exclusion, the treatment group (17 children) and the placebo group (10 children) were similar: median age of 6 and 7 y (range 4–8), median baseline and postprocedure heart rate and oxygen saturation. The median (interquartile range) for total pain score in the treatment group was 1 (0 to 4.5) and in the control group 1 (0 to 2.3). There was no significant difference in pain score between the two groups (Mann‐Whitney test, p= 0.7). The 95% confidence interval for the difference in pain score was 1.0 to +3.0.

Conclusions: The low pain score in both groups suggests the effectiveness of distraction therapy, although factors such as skill of the operator and previous experience of the patient group are of relevance. There was no significant difference in the pain score between the EMLA and placebo groups, suggesting that in this age group if carefully selected children receive distraction during venepuncture EMLA may not be necessary.
Connections between parental eating attitudes and children's meagre eating: questionnaire findings
Authors: Saarilehto S , Keskinen S , Lapinleimu H , Helenius H , Simell O
Published: August 2010

This study investigated whether young children's problematic, meagre eating is associated with the eating habits and attitudes of the parents. The subjects, 397 children, their mothers (n= 397) and fathers (n= 375) participated in a prospective atherosclerosis risk‐factor intervention trial. The parents evaluated their own eating behaviour in questionnaires when their child was 13 mo old. The children's eating problems were recorded by the mothers when the child was 13 mo old, and by both parents when the child was 5 y old. At both ages, the weight and height of the children were measured. Problematic or maladaptive eating habits of the children were found to be connected to those of their parents. The mother's poor ability to enjoy eating, high tendency to snack and low tendency to eat only when hungry, as well as the father's difficulty in maintaining ideal weight significantly predicted persistent problems of meagre eating in their children.

Conclusion: The study suggests that the eating habits and attitudes of parents may be reflected in the eating behaviour of young children.
Cord blood endothelin‐1 and perinatal asphyxia
Authors: Laforgia N , Difonzo I , Altomare M , Mautone A
Published: August 2010

Discordant data have been reported on endothelin‐1 (ET‐1), a potent endothelium‐derived vasoconstriction peptide, during the neonatal period, and elevated levels have been found in various neonatal diseases. This study evaluated ET‐1 in the cord blood of 74 neonates of different gestational age, birthweight, mode of delivery and 5′‐Apgar score.

Conclusion: Higher ET‐1 levels were found in neonates born by emergency caesarean section, and in newborns with low 5′‐Apgar score, suggesting that ET‐1 could be a marker of perinatal asphyxia.
Incarcerated inguinal hernia in premature babies‐ a report of two cases
Authors: Coren ME , Madden NP , Haddad M , Lissauer TJ
Published: August 2010

We highlight the morbidity of incarcerated inguinal hernia in very low birthweight (VLBW) infants by presenting a report of two cases. Our aim is to raise the question of the optimal timing of surgery when this common problem presents on the neonatal unit. In each of our cases the hernia was diagnosed but surgery was delayed, as per normal policy on the unit, pending growth of the baby and improvement in respiratory status. Both babies suffered significant morbidity when the hernias subsequently became acutely incarcerated.

Conclusion: In conclusion, we question whether the widespread practice of delayed surgery for inguinal hernia in VLBW infants should be reconsidered.
Lactic dehydrogenase isoenzymes in cerebrospinal fluid associated with hydrocephalus
Authors: Nussinovitch M , Volovitz B , Finkelstein Y , Amir J , Harel D
Published: August 2010

Various neurological disorders are associated with specific changes in the level of total lactic dehydrogenase and concentrations of its isoenzymes in the cerebrospinal fluid. We describe the lactic dehydrogenase isoenzyme values in children with hydrocephalus. Cerebrospinal fluid samples collected from 10 patients (2 to 16 mo) with hydrocephalus were analysed for total lactic dehydrogenase activity and lactic dehydrogenase isoenzymes. Findings were compared with those in samples from 15 paediatric patients, with normal results. Mean total lactic dehydrogenase activity in the cerebrospinal fluid was significantly higher in the patients with hydrocephalus (101 ± 23.11 U/L) than in the controls (33.53 ± 5.75 U/L) (p < 0.001). In the control samples, lactic dehydrogenase‐1 was the main fraction, followed by lactic dehydrogenase‐2 and 3; only small concentrations of lactic dehydrogenase‐4 and lactic dehydrogenase‐5 were detected. By contrast, patients with hydrocephalus had lower concentrations of the lactic dehydrogenase‐1 fraction and higher lactic dehydrogenase‐2 and lactic dehydrogenase‐3 concentrations, the differences between these results and those in the control group being statistically significant (p < 0.001). The values for lactic dehydrogenase‐4 and lactic dehydrogenase‐5 were similar in both groups.

Conclusion: Findings should be considered together with computed tomography/magnetic resonance imaging and ultrasound scans. The cerebrospinal fluid lactic dehydrogenase profile may prove to be an important predictor of cerebral injury, obstructive hydrocephalus and long‐term neurodevelopmental problems.
Comparison of brainstem auditory evoked responses recorded at different presentation rates of clicks in term neonates after asphyxia
Authors: Jiang ZD , Brosi DM , Wilkinson AR
Published: August 2010

This study examined whether high presentation rates of clicks while recording brainstem auditory evoked responses (BAER) can improve the detection of central auditory impairment in asphyxiated neonates using the BAER. The BAER was analysed at different presentation rates of clicks within the first week after birth in 38 term neonates who suffered perinatal asphyxia. At the routinely used 21 s−1 clicks all BAER wave latencies increased significantly (ANOVA, p < 0.05‐0.01). After excluding five neonates who had a significantly elevated BAER threshold, only wave V latency increased slightly (p < 0.05). The interpeak intervals of I–V and III–V also increased slightly (both p < 0.05). Similar results were found at 51 s−1 clicks. As the clicks were increased to 91 s−1, the III–V interval increased more significantly (p < 0.01) and the III–V/I–III interval ratio also increased significantly (p < 0.01). In particular, wave V amplitude reduced more significantly than that in normal term controls (p < 0.01). Compared with values in the controls, wave V amplitude reduced by 4.5%, 12.2% and 24.7% at 21, 51 and 91 s−1 clicks, respectively.

Conclusion: Although a moderate increase in the rate (e.g. 51 s−1) while recording the BAER did not improve the detection of hypoxic‐ischaemic auditory impairment, a significant increase (e.g. 91 s−1) did, which mainly indicates an abnormal reduction in wave V amplitude.
Twins and cerebral palsy
Authors: Pharoah POD
Published: August 2010

In a national follow‐up study of twin births, monozygous compared with dizygous twins were at significantly increased for both to die in utero, one to die in utero and the co‐twin to die in infancy, or both to be livebirths but both die in infancy. The prevalence of cerebral palsy among survivors of a co‐twin fetal death was 80.2 and other cerebral impairment was 107.0 per 1000. Many apparently singleton cases of cerebral palsy and impairment may be due to fetal death of a twin that has not been recognized or has been recognized but not registered.
Recent advances in the management and prophylaxis of respiratory syncytial virus infection
Authors: Greenough A
Published: August 2010

Respiratory syncytial virus (RSV) infection is an important cause of morbidity, particularly in prematurely born infants who have had chronic lung disease. Current therapy is essentially supportive. Overall, the results of randomized trials do not support the use of bronchodilators, corticosteroids or Ribavirin. Nitric oxide and exogenous surfactant may improve the respiratory status of those infants who require ventilatory support. Nosocomial infection can be reduced by appropriate handwashing. There is no safe and effective vaccine for use in infants. Immunoprophylaxis reduces hospitalization and requirement for intensive care. Palivizumab, a humanized monoclonal antibody, is preferred to RSV immune globulin as the immunoprophylactic agent. Immunoprophylaxis should be reserved for infants at highest risk of severe respiratory syncytial virus infection, if this strategy is to be used most cost‐effectively.
Recurrent abdominal pain. A world‐wide problem of organic, functional and psychosomatic aetiology
Authors: Alfvén G
Published: August 2010

This spring,Acta Paediatricais publishing five original articles underlining the importance of recurrent abdominal pain (RAP) and illustrating the scientific and diagnostic difficulties involved in understanding it. Our knowledge of organic causes is increasing with improved instruments for investigation, including 24‐h pH monitoring and endoscopy, but the difficulty in how to link findings of organic abnormalities conclusively to the symptom RAP has to be further elaborated and discussed. There is an old belief that many cases of RAP have a psychogenic aetiology. Psychometric tests in past decades, however, have not supported this belief, but if the reaction primarily is one of negative stress, than we should be looking for negative stress reactions, not for psychopathology. RAP of psychosomatic origin is not just a matter of excluding organic disease, but a diagnosis that must be built on firm positive diagnostic criteria, criteria that have not yet been elaborated for a broader public.
Low‐density lipoprotein apheresis in a patient aged 3.5 years
Authors: Stefanutti C , Giacomo S Di , Vivenzio A , Colloridi V , Bosco G , Berni A , Rabbone I , Cerutti F , Bertolini S
Published: August 2010

A 3.5 y‐old girl carrying a severe mutation of the LDL‐receptor gene known as “FH Pavia”, affected by homozygous familial hypercholesterolemia (FH), and at high risk of developing coronary artery atherosclerosis was treated with selective dextran sulphate cellulose (DSC) column low‐density lipoprotein apheresis (LDL‐a). This is the youngest patient ever treated with LDL‐a. Plasma total cholesterol (982 mg/dl) and LDL‐cholesterol (939mg/dl) (T‐Chol, LDL‐Chol) levels at baseline showed a transient decrease: –13.4%, and –16.8%, respectively, after 9 mo of combined treatment with a diet, cholestyramine (max. 12g/d) and atorvastatin (max. 30mg/d). However, the drugs were discontinued because of intolerance and an increase in aminotransferases and creatine phosphokinase in the plasma. Moreover, after 9 mo of this therapy, the mean plasma T‐Chol and LDL‐Chol levels were still high (930 mg/dl and 869.5 mg/dl, respectively). Therefore, 9 consecutive treatments with LDL‐a were carried out every 15 d (plasma volumes treated: 1000–1700 ml). Mean plasma T‐Chol, LDL‐Chol, triglycerides (TG), and Lp(a) decreased significantly: –75.5%, –77.2%, –67.5% and −50.8%, respectively. HDL‐cholesterol (HDL‐Chol) concentration was considerably decreased immediately after apheresis because of haemodilution (X: −45.1%).

Conclusion: LDL‐a treatment improved the plasma apo B 100‐containing lipoproteins–LDL, Lp(a)‐profile in a homozygote with a severe inherited disorder in which coronary artery atherosclerosis frequently has its clinical onset before 10 y of age. At the time of this report, no significant side effects had been observed.
Small bowel capsule biopsy in children: parents' opinions on children's discomfort
Authors: Högberg L , Nordwall M , Stenhammar L
Published: August 2010

This questionnaire study asked the parents of 62 children undergoing small bowel capsule biopsy for their reactions to the discomfort experienced by their children. The children were randomized to receive sedation with midazolam either intravenously or intranasally. With regard to the biopsy procedure the parents of 94% of the children had no objections. The parents of 3% of the children found the biopsy very unpleasant and another 3% suggested that the biopsy should be performed under general anaesthesia. The proportion of parents with negative reactions to the biopsy procedure did not differ significantly between the intravenously and intranasally sedated children. With regard to the sedation given, the parents of 79% of the children did not think that their children were in any discomfort at all. Ten percent of the children had obvious signs of nasal discomfort using the intranasal administration. In the remaining 11% of the children the parents reported various symptoms.

Conclusion: The vast majority of parents of children undergoing small bowel capsule biopsy found the procedure satisfactory providing that the sedative medication was given intravenously rather than intranasally.
Gastrin, somatostatin and infantile hypertrophic pyloric stenosis
Authors: Dick AC , Ardill J , Potts SR , Dodge JA
Published: August 2010

Despite multiple and often contradictory research, no firm conclusions regarding the role of hypergastrinaemia in infantile hypertrophic pyloric stenosis (IHPS) have been established. Evaluation of somatostatin, the main physiological antagonist of gastrin, has not been assessed in previous studies. Long‐term evaluation following pyloromyotomy suggests persistent abnormalities in gastrin and somatostatin in IHPS. The objective of this case‐controlled study was to compare fasting serum gastrin and somatostatin levels in IHPS. Serum sample were collected from 39 children with IHPS at the time of pyloromyotomy and 20 age‐matched controls with no evidence of gastrointestinal disease. Standard radioimmunoassay techniques were used to detect circulating levels of the hormones. A two‐tailed t‐test was used for statistical analysis. The levels of the two hormones (mean ± SEM) revealed that there was no evidence of hypergastrinaemia in IHPS compared with controls (75.6 ±16.1 and 68.1 ± 7.8 ng l−1, respectively), but that the level of somatostatin was significantly elevated (38.9 ±6.4 and 30.5 ± 5 8 ng l−1, p = 0.016). An inverse trend in the gastrin/somatostatin levels could not be identified in IHPS.

Conclusion: Somatostatin but not gastrin is raised in IHPS. Somatostatin is known to inhibit the actions of inhibitory neurotransmitters in the pylorus and may explain the development of pylorospasm, which is believed to be important in the development of pyloric tumours. These results do not agree with a previous long‐term follow‐up study, but reflect the hormonal imbalance at the time of pyloric hypertrophy.
Iron‐fortified and unfortified cow's milk: Effects on iron intakes and iron status in young children
Authors: Virtanen MA , Svahn CJE , Viinikka LU , Raiha NCR , Siimes MA , Axelsson IEM
Published: August 2010

Iron intakes and iron status were evaluated in 36 young Swedish children given either iron‐fortified or unfortified cow's milk. All children had good iron status and had received breast milk or ironfortified formulae during infancy. Twenty 1‐y‐old children were randomized to a diet with iron‐fortified milk (7.0 or 14.9 mg Fe T−1) and 16 to a diet with unfortified milk. The iron intakes in the unfortified group at 15 and 18 mo (mean ± SD 5.19 ± 2.29 and 5.84 ± 1.62 mg d−1) were low in relation to Nordic Nutrition Recommendations, while the intakes in the iron‐fortified group (10.20 ±2.60 and 10.87 ± 2.79 mg d−1) were normal in relation to recommendations. The gain (increase) from receiving fortified diet during the study period was at most [upper limit for 95% confidence interval (CI)] 2.6 g T−1 in blood haemoglobin, 1.9 fl in mean corpuscular volume, 2.7 Limol in serum iron and 4.5% in transferrin iron saturation, and the gain (decrease) was at most (lower limit for 95% CI) 0.29 g T−1 in serum transferrin and 0.9 mgr−1 in serum transferrin receptor (TfR). None of these differences was statistically significant. There was an almost significantly higher increase in serum ferritin (1.4 times higher relation of values at the end compared with the beginning, p= 0.06) and a significantly higher (1.2; p= 0.047) decrease in TfR/ log10 ferritin ratio in the fortified group.

Conclusion: One‐year‐old children starting out with good iron status given either iron‐fortified or unfortified cow's milk from 12 to 18 mo maintain sufficient iron status during this period. However, children fed unfortified cow's milk have an iron intake which is low in relation to recommendations and the quantitative development of their reserve iron in iron stores seems to be weaker than that of the fortified group. The consequences of this require further study.
Precocious puberty in children with tumours of the suprasellar and pineal areas: Organic central precocious puberty
Authors: Rivarola MA , Belgorosky A , Mendilaharzu H , Vidal G
Published: August 2010

During the past 11 y, 115 children younger than 8/9 y of age (female/male) with tumours of the suprasellar or pineal areas were followed in our clinic to study the incidence of precocious puberty. In addition, type of central lesion, clinical characteristics and gonadotropic secretion were studied in order to elucidate the different mechanisms of gonadal activation. A control group of 21 patients with idiopathic precocious puberty and a control group of 10 age‐matched patients with suprasellar tumours without precocious puberty were also studied. Precocious puberty associated with organic central lesions was found at diagnosis in 30 patients (26%), in 9 out of 48 patients with glial cell tumours (18.7%), 6 out of 9 patients with gem cell tumours (66.6%), 11 out of 11 patients with hypothalamic hamartomas (100%) and in 4 out of 4 patients with subarachnoid cysts or arachnoidocele (100%). Precocious puberty was not found in any of 36 patients with craniopharyngioma. With the exception of one patient with pineal germinoma, all lesions were localized to the suprasellar area. In all patients with hypothalamic hamartoma, precocious puberty was diagnosed before 4 y of age, while in most patients with the other lesions, it was diagnosed after this age. Height SDS, weight increase and advancement of bone age were similar in both idiopathic and organic central precocious puberty. Maximal LH responses to GnRH in idiopathic and organic central precocious puberty were similar except for germ cell tumours. Patients with suprasellar tumours without precocious puberty had lower maximal LH (but not FSH) responses to GnRH, with the exception of germ cell tumours. In the latter, elevation of serum β‐hCG indicates that this gonadotropin was responsible for gonadal stimulation. In hypothalamic hamartomas, the prepubertal hiatus in the activity of the GnRH pulse generator was absent. The mechanism of this failure in the inactivation of GnRH is unknown. Data suggest that in glial cell tumours and in subarachnoid cysts, an unknown factor, probably secreted by the tumours, advances the tempo of GnRH maturation. Therefore, the aetiology of organic central precocious puberty is multiple and is directly related to location and type of lesion.

Conclusion: This clinical information suggests that the onset of puberty is not the result of the disruption of a putative pulse generator inhibitory influence but the consequence of secretion of stimulatory substances by the lesions.
Spectrum of outcome in infants with extreme neonatal jaundice
Authors: Hankø E , Lindemann R , Hansen TWR
Published: August 2010

The increasing number of case reports on neurologic sequelae related to hyperbilirubinaemia may represent a re‐emergence of kernicterus in the industrialized world. However, not much has been written about infants who survived extreme levels of serum bilirubin without neurologic damage. We present three cases of extreme neonatal hyperbilirubinaemia, all with peak serum bilirubin levels >600 mmol/L. Two of the infants developed neurologic sequelae, but the third infant did not. In contrast to the two with sequelae, the infant without sequelae was female, had a positive Coombs' test, less clinical signs compatible with bilirubin encephalopathy, and a shorter exposure to serum bilirubin values >400 mmol/L.

Conclusion: The basic mechanism of bilirubin neurotoxicity remains unknown, and it is not clear why some infants do not develop neurologic injury at serum bilirubin levels at which others do. We speculate that a comparison between patients with sequelate and those without may yield important information.
Childhood acute rheumatic fever in Greece: Experience of the past 18 years
Authors: Giannoulia‐Karantana A , Anagnostopoulos G , Kostaridou S , Georgakopoulou T , Papadopoulou A
Published: August 2010

This study reports on the authors' experience with acute rheumatic fever (ARF) during the years 1980–1997. The objectives were to estimate the incidence of the disease an area of Greece to characterize its epidemiology, to determine the frequency of the antecedent symptoms and to describe its clinical presentation. The medical records of 66 confirmed cases admitted to the First Department of Pediatrics, “Aghia Sophia” Children's Hospital, were reviewed. Two outbreaks occurred during this period. In contrast to the 3–4 cases seen every year, 14 cases were diagnosed during the 6 mo period from October 1989 to March 1990. An additional 10 cases were diagnosed in 1993. Most of the children (76%) were between 8 and 14 y old. The children were predominantly from middle‐class families with ready access to medical care. Carditis, evident by auscultation, and arthritis were the dominant major manifestations in 70% and 68% of the cases, respectively. Mild carditis was present in 54% of children with valvular disease.

Conclusion:ARF exists in the paediatric Greek population with exacerbations and remissions, but the cardiac manifestations appear mild or moderate.
Early discharge of preterm infants followed by domiciliary nursing care: parents' anxiety, assessment of infant health and breastfeeding
Authors: Örtenstrand A , Winbladh B , Nordström G , Waldenström U
Published: August 2010

The aim of this study was to evaluate the effect of early discharge of preterm infants, followed by domiciliary nursing care, on the parents'anxiety, their assessment of infant health and breastfeeding. Seventy‐five families including 88 preterm infants who were physiologically stable but in need of further special care, such as gavage feeding, were allocated to an early discharge group (EDG) that was offered home visits (n= 40), or to a control group offered standard neonatal care (CG) (n= 35). Seventy families (37 in the EDG and 33 in the CG) completed the study to the 1‐y follow‐up. Data were collected by means of questionnaires on three occasions: in the EDG, at hospital discharge, on completion of the domiciliary care programme and after 1 y, and in the CG at the corresponding points in time, which were during hospitalization, at hospital discharge and after 1 y. No statistical differences were observed between the groups in emotional well‐being, except that mothers in the EDG had a lower level of situational anxiety at the time of hospital discharge compared with CG mothers whose infants remained in hospital. One year after the birth, the EDG mothers said they had felt better prepared to take responsibility for the care of their babies after completion of the domiciliary care programme, in contrast to CG mothers. However, no statistical differences were observed in the recollection of anxiety, confidence in handling the baby and periods of mental imbalance. No statistical difference was observed in breastfeeding rates between the groups. Fathers in the EDG group tended to perceive their babies as being healthier, compared with CG fathers.

Conclusion: Early discharge of preterm infants followed by domiciliary nursing care did not seem to have any major effect on the parents' anxiety and their assessment of infant health.
Screening of rotavirus and adenovirus infections during prolonged hospitalization in a neonatal unit
Authors: Hällström M , Vesikari T , Janas M , Ikonen S , Tammela O
Published: August 2010

Rotavirus and adenovirus infections in 308 infants hospitalized for longer than 1 wk, and cases with necrotizing enterocolitis, were screened in a neonatal unit during a 15 mo period, covering two rotavirus epidemics in the community. Altogether, 1020 stool samples were collected weekly until hospital discharge, and in necrotizing enterocolitis cases at the onset of symptoms, and tested for rotavirus and adenovirus by means of enzyme‐linked immunosorbent assay. The positive samples were further analysed by polymerase chain reaction. Enzyme‐linked immunosorbent assay revealed five adenovirus‐positive cases, which were tested negative by polymerase chain reaction. Out of 16 necrotizing enterocolitis cases, one was adenovirus‐ and another rotavirus positive when tested by polymerase chain reaction, the latter having a concomitant Candida albicans septicaemia.

Conclusion: Routine rotavirus and adenovirus screening in hospitalized neonates seems to be unnecessary. Viral diagnostic examinations should be considered in patients with necrotizing enterocolitis.
Early dexamethasone decreases expression of activation markers on neutrophils and monocytes in preterm infants
Authors: Nupponen I , Repo H , Kari A , Pohjavuori M , Andersson S
Published: August 2010

Aim: To investigate the effects of early dexamethasone administration on activation of circulating neutrophils and monocytes in preterm infants with respiratory distress syndrome requiring treatment with surfactant. Methods: Neonates (n= 30) with respiratory distress were randomized to receive dexamethasone (DEX group, 29.1 ± 1.2 wk, 1223 ± 156 g, n= 15) from the first postnatal day, or to serve as controls (control group, 29.2 ± 1.4 wk, 1250 ± 148 g, n= 15). Dexamethasone was given as a 4 d course (0.5 mg kg−1 on postnatal days 1 and 2, and 0.25 mg kg−1 on days 3 and 4). Polymorphonuclear leucocyte (PMN) and monocyte surface expression of CD11b, L‐selectin and CD14 was quantified with flow cytometry, and plasma macrophage‐inflammatory protein‐1α (MIP‐1α) with an enzyme‐linked immunosorbent assay. Blood samples were collected on days 1, 2–3 and 5–7. Results: In the DEX group 1/15, and in the control group 7/15 developed bronchopulmonary dysplasia (p < 0.04). PMN CD11b (median 100, range 70‐190 vs 154, 96–213, p= 0.01), monocyte CD14 (235, 102–433 vs 355, 219–533, p= 0.01) and plasma MIP‐1α (20 ng 1−1, 20–32 vs 37 ng 1−1, 20–70, p= 0.005) were lower in the DEX group at days 2–3. All adhesion molecule expression and plasma MIP‐1α levels were comparable at days 5–7, with the exception of monocyte L‐selectin expression levels, which remained lower in the DEX group.

Conclusion: In preterm infants with respiratory distress syndrome, early dexamethasone causes downregulation of PMN and monocyte activation. This may attenuate pulmonary inflammation and improve pulmonary outcome.
Asthma hospitalizations continue to decrease in schoolchildren but hospitalization rates for wheezing illnesses remain high in young children
Authors: Wennergren G , Strannegård I‐L
Published: August 2010

Aim: To analyse changes in hospitalization rates for asthma in children during recent years. Methods: In a population‐based analysis, changes in asthma hospitalization rates were studied in children in Göteborg (Gothenburg), the second largest city in Sweden, during 1985‐2000. The changes in different age groups have been correlated with the delivery of inhaled corticosteroids to the age groups. Results: In the 5 to 18‐y age group, there was a continuous, significant decrease in number of hospital days, admissions and individual patients admitted for asthma not only for the entire study period, 1985‐2000, but also during the past 10‐y period. The number of hospital days in the year 2000 was only 6% of the figure for 1985. An inverse correlation between delivery of inhaled corticosteroids and hospitalization for asthma was seen not only during 1985‐1995, when use of inhaled corticosteroids became widespread (rS=−0.95, p= 0.007 for hospital days), but also when the entire period from 1985 to 2000 was analysed. Conversely, in the 0 to 1‐y and 2 to 4‐y age groups, there was no decrease in hospitalizations for wheezing illnesses or asthma‐like symptoms during the past 10‐y period, 1991‐2000.

Conclusion: During the period 1985‐2000 the number of hospital days owing to asthma decreased by more than 90% in the 5 to 18‐y age group. The marked decrease in asthma hospitalization rates among schoolchildren represents a great advance in paediatric respiratory medicine, which has been continuous during the past 10‐y period. However, in young children admissions for wheezing have apparently not decreased.
Effect of a microaerosol filter on spirometry in children with cystic fibrosis
Authors: Rogers D , Doull IJM
Published: August 2010

Aim: To measure the effect of an in‐line microaerosol filter on spirometric values in cystic fibrosis (CF). Methods: Twenty‐six subjects with CF undertook a randomized, open, cross‐over comparison of spirometry with and without an in‐line filter. Results: The filter had no significant effect on spirometric parameters nor was there any order effect. Measurement error was unrelated to the magnitude of the measurement.

Conclusion: In‐line microaerosol filters do not affect spirometric values or variability in children with CF.
ORACLE—antibiotics for preterm prelabour rupture of the membranes: short‐term and long‐term outcomes
Authors: Kenyon S , Taylor DJ , Tarnow‐Mordi WO ,   ORACLE Collaborative Group
Published: August 2010

Preterm prelabour rupture of the foetal membranes (pPROM) is the most common antecedent of preterm birth and can lead to death, neonatal disease and long‐term disability. Previous small trials of antibiotics for pPROM suggested some health benefits for the neonate, but the results were inconclusive. A large, randomized, multicentre trial was undertaken to try to resolve this issue. In total, 4826 women with pPROM were randomized to one of four treatments: 325 mg co‐amoxiclav plus 250 mg erythromycin, co‐amoxiclav plus erythromycin placebo, erythromycin plus co‐amoxiclav placebo, or coamoxiclav placebo plus erythromycin placebo, four times daily for 10 d or until delivery. The primary outcome measure was a composite of neonatal death, chronic lung disease or major cerebral abnormality on ultrasonography before discharge from hospital. The analysis was undertaken by intention to treat. Indications of short‐term respiratory function, chronic lung disease and major neonatal cerebral abnormality were reduced with the prescription of erythromycin. In contrast, the use of co‐amoxiclav was associated with a significant increase in the occurrence of neonatal necrotizing enterocolitis.

Conclusion: Prophylactic antibiotics can play a role in preterm prelabour rupture of the membranes in reducing infant morbidity.
Brain damage markers in children. Neurobiological and clinical aspects
Authors: Leviton A , Dammann O
Published: August 2010

The presence in blood of proteins normally confined to the cytoplasm of brain cells is considered peripheral evidence of brain damage. Only recently have these proteins been measured in the blood of children at risk of brain damage. To show the value and limitations of measuring these proteins, we review their biology and the adult literature that has correlated the blood concentrations of these proteins with lesion size and dysfunction.

Conclusion: We conclude that brain damage markers will increasingly be measured in the blood of newborn s and other children at risk of brain damage.
Laboratory‐confirmed reinfections with Bordetella pertussis
Authors: Versteegh FGA , Schellekens JFP , Nagelkerke AF , Roord JJ
Published: August 2010

Susceptibility to infection with Bordetella pertussis re‐emerges several years after pertussis vaccination. However, the duration of immunity after natural infection with B. pertussis, postulated to be lifelong, is not known. In an ongoing study, the longitudinal course of pertussis antibodies in patients who have had laboratory‐confirmed pertussis is being followed using sera obtained at irregular intervals. In 4 patients a reinfection with Bordetella pertussis is described respectively 7 (patient A), 12 (patients B and C) and 3.5 (patient D) y after the first infection. It seems that the longer the interval between the infections the more severe the complaints.

Conclusion: To the authors' knowledge, these are the first patients in whom symptomatic reinfection with B. pertussis has definitely been proven by laboratory confirmation of both episodes. Bordetella pertussis infection should be considered in patients with symptoms of typical or atypical whooping cough, irrespective of their vaccination status or previous whooping cough.
Variation in size at birth in infants born small for gestational age in Lithuania
Authors: Verkauskiené R , Wikland K Albertsson , Niklasson A
Published: August 2010

The aim of this study was to describe the heterogeneity in body proportions of infants born small for gestational age (SGA), defined by birthweight, and to study the relationship of placental size with neonatal anthropometric measurements. Anthropometry was evaluated in 107 symmetrically and asymmetrically growth‐retarded infants born SGA (birthweight <−2 SD) and compared with 181 appropriate‐for‐gestational age infants (AGA; birthweight and length ± 2 SD). Study children were born at Kaunas University Hospital during the period from 1 January 1998 to 25 August 2000. Two‐thirds of SGA children were light (SGAW) and one‐third was both light and short (SGAWL) for gestational age. Infants in both SGA groups were significantly leaner than AGA children. SGAWL infants had significantly larger heads in relation to their length compared with SGAW and even AGA children, probably indicating a brain‐sparing effect. SGAWL children had the lowest mean placental weight, but the highest placental weight to birthweight (PW/BW) ratio. The PW/BW ratio was inversely correlated with most infant measurements; the strongest negative relationship was observed with birthlength and lower leg length.

Conclusion: There is heterogeneity in children born SGA, defined by birthweight. It is suggested that the two SGA groups represent the continuum of intrauterine growth retardation, with an initial reduction in trophic growth and a subsequent retardation of linear growth. The PW/BW ratio is a strong indicator for impaired prenatal linear growth.
Free sialic acid storage (Salla) disease in Sweden
Authors: Erikson A , Aula N , Aula P , Månsson J‐E
Published: August 2010

The first 23 patients diagnosed with Salla disease in Sweden are presented. A high incidence of the “Finnish” R39C mutation, together with genealogical data, indicates that a large proportion of the mutations are of Finnish origin. All patients had pathologically high levels of free sialic acid in urine and in fibroblasts. The clinical picture confirms what has already been reported from Finland, with early psychomotor retardation, ataxia and speech problems. One‐third of the patients had epilepsy.

Conclusions: Salla disease is more common in Sweden than supposed. A large proportion of the mutated alleles seem to be of Finnish origin. The clinical picture is the same as that reported from Finland.
Risk factors for language impairment in Swedish bilingual and monolingual children relative to severity
Authors: Salameh EK , Nettelbladt U , Gullberg B
Published: August 2010

Aim: To explore potential risk factors for language impairment (LI) relative to degree of severity in bilingual and monolingual children. Methods: Two groups of clinically assessed children were compared, 252 bilinguals whose parents were both non‐Swedish and 446 monolinguals, who were referred over a period of 24 mo to the University Hospital in Malmo for suspected LI. Results: A multivariate linear regression for both groups showed that two risk factors were the same: parental distress (p > 0.0001 in both groups) and short attention span (p > 0.0001 in both groups). Male gender (p > 0.0001) was an additional predictor for LI relative to degree of severity in the monolingual group. Specific risk factors for LI relative to degree of severity in the bilingual children were maternal arrival within 1 y in relation to birth (p > 0.002) and parental need for an interpreter after >5 y in Sweden (p > 0.040).

Conclusion: Most risk factors for LI relative to degree of severity in this study seemed to apply to both groups, although they sometimes appeared in another form in the bilingual group. Gender and possibly also hereditary factors seemed to need to interact with environmental factors to appear as risk factors for the bilingual children in this study.
Decline of maternal hepatitis A virus antibody levels in infants
Authors: De Silvestri A , Avanzini MA , Terulla V , Zucca S , Polatti F , Belloni C
Published: August 2010

Hepatitis A is a common viral infection causing substantial morbidity and mortality. The anti‐hepatitis A virus (HAV) vaccination in infants would guarantee control of the infection. However, the immunogenicity of the HAV vaccine in infants could be impaired by the presence of passively acquired maternal HAV antibodies. This study evaluated the prevalence of HAV antibodies in 103 women at delivery and in their babies in the first year of life. Eighteen mothers (17.5%) had anti‐HAV serum level < 10 mIU ml‐1. In their infants the anti‐HAV level was still positive in 11 out of 18 (61.1%) at 12 mo. Two out of 85 infants born to anti‐HAV‐negative mothers and anti‐HAV negative at birth were found to be positive at 5 mo of age.

Conclusion: It is proposed that all women be screened at delivery for anti‐HAV antibodies. Children born to anti‐HAV‐negative mothers could be vaccinated early during the first year of life, whereas vaccination could be postponed in children born to anti‐HAV‐positive mothers, if necessary.
Anogenital bacteriology in non‐abused preschool children: a descriptive study of the aerobic genital flora and the isolation of anogenital Gardnerella vaginalis
Authors: Myhre AK , Bevanger LS , Berntzen K , Bratlid D
Published: August 2010

The purpose of the study is to describe the genital aerobic bacterial flora including Gardnerella vaginalis in girls and the occurrence of anal G. vaginalis in both genders. From a group of 3773 children, 278 (99 boys and 179 girls) with a mean age of 5.63 y (range: 5.13–6.73) were recruited. Inclusion in the study was based on self‐selection, whereby parents who did not suspect any occurrence of sexual abuse of their child gave informed consent to participate. Several mechanisms were undertaken to exclude abused children. At least one bacterial species was isolated from the genitals of 59 (33.9%) girls. Most isolates (39 out of 99) were bacteria representing skin flora (staphylococci and coryneform organisms), with viridans streptococci and related organisms as the second most common group of isolates (31 out of 99). S. anginosus was the single most frequent bacterial species identified (17 isolates). Streptococcus pyogenes was isolated from the genitals of two girls, Streptococcus pneumoniae from one girl and Haemophilus influenzae from eight girls. G. vaginalis was not isolated from the genitals in any girl, but the organism was isolated from the anal canal in three children.

Conclusion: A large number of different aerobic organisms were identified from the genital area. G. vaginalis was rare and only isolated from the anal canal.