bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical, laboratory and molecular characteristics of children with Familial Mediterranean Fever‐associated vasculitis
Authors: Tekin M , Yalçinkaya F , Tumer N , Akar N , Misirlioǧlu M , Çakar2 N
Published: August 2010

Familial Mediterranean Fever (FMF) is an autosomal recessive disease characterized by recurrent self‐limited attacks of fever accompanied by peritonitis, pleuritis and arthritis. Approximately 5% of individuals with FMF have been reported to have Henoch‐Schonlein purpura (HSP) and about 1% have polyarteritis nodosa (PAN). Protracted febrile myalgia is another vasculitis‐associated clinical entity among patients with FMF. Recently, the gene responsible for FMF, MEFV, has been cloned and four missense mutations (M680I, M694V, V726A and M694I) have been described. In this report, we present clinical and laboratory findings and mutation results of 23 children with FMF‐associated vasculitis. HSP, PAN and protracted febrile attacks have been diagnosed in 11, 2 and 10 children, respectively. Mutation analysis shows that 3 children are homozygotes for the M694V mutation and 11 are compound heterozygotes for 2 of the studied mutations. M694V/V726A mutations were identified in 8, M694V/M694I in 2 and M680I/M694V in 1 of these children. In six children only one mutation was found and in three none of the studied mutations were identified. This study confirms that most children with FMF‐associated vasculitis have identifiable mutations in the MEFV gene. Environmental and/or other genetic factors are possibly involved in the pathogenesis of vasculitis in FMF; elucidation of these mechanisms will help to understand pathogenesis of childhood vasculitides. ?Children, Familial Mediterranean Fever, MEFV mutations, vasculitis
Growth patterns of breastfed infants in seven countries
Authors:   WHO Working Group on the Growth Reference Protocol,   WHO Task Force on Methods for the Natural Regulation of Fertility
Published: August 2010

An international effort is underway to develop a new international growth reference for assessing the growth of young children, especially breastfed infants who appear to falter relative to the currently recommended National Center for Health Statistics/World Health Organization reference. While limited data from high socioeconomic status children from different parts of the world suggest that their growth patterns are similar, there is no comprehensive study of breastfed infants. The WHO Multinational Study of Breastfeeding and Lactational Amenorrhea provides bi‐weekly weights and 2‐4 weekly length measurements on breastfed babies from selected sites in Australia, Chile, China, Guatemala, India, Nigeria and Sweden. Multi‐level modelling was used to analyse between‐site differences in the growth of approximately 120 infants per site, after adjustment for maternal stature and infant feeding pattern. All mothers were literate and mean educational levels were well above national averages, but the study was not restricted to infants of high socioeconomic status. Maternal education was significantly associated with infant weight only in India. The growth curves of infants from most sites were strikingly similar, but relative to the Australians (the reference category), the Chinese babies were about 3% shorter at 12 mo of age and the Indians up to 15% lighter. The present results suggest that breastfed babies from reasonably well‐off families in different continents show very similar growth patterns. However, it is important that the growth of children from South and East Asian populations be rigorously assessed in the process of developing the new international growth reference. This paper discusses the relative importance of environmental versus genetic influences in the growth of young children and illustrates the complexities involved in the analysis of growth data.
A future for neonatal α1‐antitrypsin screening?
Authors: Sveger T , Thelin T
Published: August 2010

A WHO expert group recommends neonatal screening for α1‐antitrypsin deficiency (α1ATD). Homozygous α1ATD PiZZ occurs in 1 in 5000 of the U.S. Caucasian population and up to 1 in 500 individuals of the European population, with a large regional variation. It is a risk factor that predisposes mainly to liver disease in early infancy and emphysema in early adulthood. Most importantly, smoking decreases the duration of the asymptomatic phase and life expectancy by 10‐20 y. The Swedish α1AT screening programme and subsequent information and advice prevented the majority of adolescents from starting to smoke. The involved parents and α1ATD adolescents retrospectively recommended neonatal screening. Potential advantages of neonatal α1AT screening are: early diagnosis and treatment of neonatal liver disease, optimal treatment of fever and bacterial infections theoretically preventing liver cell damage, genetic advice and information about the consequences of passive and active smoking. Potential advantages of postponing screening until age 11‐12 y are: identification of α1ATD close to the age when smoking may start, and possibility for the child to take part in the screening decision. Disadvantages of α1AT screening are: psychosocial reactions–the mother probably being most vulnerable in the neonatal period–and discrimination by insurance companies and employers.

Important uncertainties are: lack of knowledge concerning participation in a voluntary α1AT screening, psychosocial reactions and the efficacy of anti‐smoking advice if the information is given to school‐age children and families. Thus the question whether and when to screen for α1ATD is still the topic of lively debate.
High total antioxidant activity and uric acid in tracheobronchial aspirate fluid of preterm infants during oxidative stress: an adaptive response to hyperoxia?
Authors: Vento G , Mele MC , Mordente A , Romagnoli C , Matassa PG , Zecca E , Zappacosta B , Persichilli S
Published: August 2010

The effect of O2 exposure, expressed by mean daily fractional inspired oxygen concentration (FiO2), was evaluated during the first 6 d of life in the tracheobronchial aspirate fluid of 16 mechanically ventilated preterm infants in terms of both antioxidant response and oxidative damage, by measuring total antioxidant activity, uric acid concentrations and protein carbonyl content. Each day linear regression analysis was performed and a positive correlation was found between total antioxidant activity and FiO2 during the study period, especially on day 2 of life (r= 0.91, p < 0.0001), but uric acid correlated only in the first 3 d, especially on the 2nd day (r= 0.83, p < 0.0001). No correlation was found between carbonyl content and FiO2. The highest values of total antioxidant activity (416 and 790 μmol l−1) were found in 2 babies ventilated with highest FiO2: 1 and 0.80, respectively. Total antioxidant activity was not detectable or was very low in the babies not requiring O2 therapy. The highest value of uric acid (270 μmol l−1) was found in the baby ventilated with 100% oxygen. Uric acid concentrations obtained in these babies were much higher then those reported in the bronchoalveolar lavage fluid of adults.

Preterm babies seem to have an antioxidant response in the tracheobronchial aspirate fluid following an oxidative stress and uric acid may be physiologically important as an antioxidant of the respiratory tract, especially during the first days of life.
Recurrent pain symptoms in children and parents
Authors: Borge AIH , Nordhagen R
Published: August 2010

Recurrent pain in five different areas (stomach, arms & legs, head, back and neck & shoulders) in a population of 348 school children and their parents has been investigated. The study presented here is restricted to 229 mother‐father‐child trios. Forty‐four percent of the children reported pain in at least one area compared to 60% of the mothers and 51% of the fathers. Headache and pains in arms and legs were most common in boys. The most frequent pain sites for girls were head and back. Overall, girls complained more than boys. No significant associations between complaints in parents and their children were demonstrated, analysed by logistic regression analysis. Furthermore, there was no significant association between the reported pain in the mother and father.

Conclusion: Children's pain did not associate with parental pain in this study. The results do not support previous hypotheses that recurrent pain clusters in families.
Diagnosis and prognosis of wheezing disorders in young children in the city of São Paulo, Southeast Brazil
Authors: Cardoso MRA , Cousens SN , Alves FM , Ribeiro MMM , Neto BP Abreu
Published: August 2010

Three‐hundred‐and‐ninety‐seven children aged 2–59 mo presenting to the paediatric emergency departments of five public hospitals in São Paulo, Brazil, with an acute episode of lower respiratory disease were examined. The children were classified into the following diagnostic categories: acute bronchitis, acute bronchiolitis, pneumonia, asthma, post‐bronchiolitis wheezing and wheezing of uncertain aetiology. Three years after the initial study, the homes of the children diagnosed as asthmatic or as having wheezing of uncertain aetiology were visited to collect information on subsequent episodes of lower respiratory disease. This paper reports the proportional incidence of different categories of lower respiratory disease and the results of an analysis to investigate clinical features that might distinguish wheezing children between those with asthma and those with an infectious disease. The predictions made for children with wheezing of uncertain aetiology were then compared with the follow‐up data. Recurrent wheezing disorders (asthma, post‐bronchiolitis wheezing) were common in the study sample (47% of children). Thirty‐six percent of children with an initial diagnosis of wheezing of uncertain aetiology were diagnosed as asthmatic by another doctor over the next 3 y. We were unable to identify any clinical features that were useful in identifying those children likely to be diagnosed subsequently as asthmatic.

Conclusions: The use of a diagnostic category similar to that which we have called “wheezing of uncertain aetiology” might help to alert physicians early to the possibility of asthma without interfering in the management of the illness. Such a classification might also be useful in epidemiological investigations of the aetiology of lower respiratory diseases.
Quality of evidence for the present Swedish child health surveillance programme
Authors: Bremberg S
Published: August 2010

The present Swedish health surveillance programme includes 15 examinations by a nurse, 5 examinations by a physician, 7 assessments of development, 2 assessments of hearing and 1 assessment of visual acuity. The WHO criteria for evaluation of screening programmes can be applied to the Swedish health surveillance programme. These criteria state that the health problem must be important, that there should be an early phase during which the condition is only detectable by medical professionals and that treatment at an early phase should favourably affect the prognosis. The quality of evidence for fulfilment of these criteria has been graded I‐III. Grade II‐2 refers to evidence obtained from well‐designed cohort or case‐control analytical studies. The following disorders might be affected by health surveillance at child health centres: amblyopia, ADHD/DAMP, failure to thrive, cerebral palsy, congenital heart failure, congenital luxation of hip, hearing impairment (severe or moderate), mental retardation, retentio testis and hydrocephalus. None of these conditions fulfils the WHO criteria with quality of evidence grade II‐2 or better.

Thus, the evidence for the present Swedish health surveillance programme is problematic.
How to prevent exposure to tobacco smoke among small children: a literature review
Authors: Arborelius E , Hallberg A‐C , Håkansson A
Published: August 2010

There are many reviews of current knowledge about smoking cessation in general within the health service, which also contain guidelines about smoking cessation during pregnancy. Our aim was to review methods in child healthcare for preventing the exposure of children to tobacco smoke. Since passive smoking starts during pregnancy, we also considered methods in antenatal care. We did a search for relevant articles, especially on randomized, controlled trials, in various databases, chiefly Medline. We mainly analysed studies from the last 10 y, concentrating on the actual interventions. In antenatal care the greatest effect comes from interventions based on behavioural strategies. These can lead to a doubling of the number of women who stop smoking during pregnancy. Purely factual information, on the other hand, has no great effect.

The studies in child healthcare analysed here show that decisive factors for children not being exposed to passive smoking are a concentration on strengthening the parents' faith in their ability to create a smoke‐free environment, and on behavioural strategies to achieve this goal, but not primarily on getting the parents to stop smoking. However, we need further studies of different types of interventions, geared to smokers with small children, before more specific recommendations can be given as to how child healthcare should design its tobacco‐preventive work.
Allelic association of gene markers on chromosome 11q in Italian families with atopy
Authors: Rigoli L , Salpietro DC , Lavalle R , Cafiero G , Zuccarello D , Barberi I
Published: August 2010

In our study, the genetic linkage of the Fcε RIβ gene with atopy in 77 affected sibling pairs recruited from an Italian panel of 201 subjects has been examined. Atopy was defined by the presence of a positive skin prick test to one or more common aeroallergens, a positive RAST test to one or more common aeroallergens and an elevated circulating total IgE. Genotype analysis was performed by PCR amplification of Fcε RIβ CA and C111 ‐319 CA microsatellites. All the family members were also tested for the IIε 181 mutation with the ARMS method and for Leu181/Leu183 polymorphism. Seventy‐two point five percent (72.5%) of the affected sibling pairs shared their maternal allele and 27.5% did not. Therefore, an increased maternal allele sharing was observed: x2= 8.10, p < 0.01. Comparing paternal versus maternal allele sharing, a significant difference was observed for the CIII‐319 CA marker (x2= 4.32, p < 0.05). Atopy phenotype with positive skin prick test, RASTs, and high total serum IgE also showed greater sharing of maternal than paternal alleles in affected sibling pairs. Of the 201 subjects studied, 17 (8.4%) were positive for Leu181. Ten of these were children and seven (70%) had inherited the variant maternally. The seven children had maternally inherited Leu181/Leu183 and were atopic. Within this sample the maternal inheritance of FCE RIP Leu181/Leu183 was associated with an increased risk of IgE responses to common allergens, raised eosinophil counts and increased skin prick test reactions. Therefore, the variant identified a genetic risk factor for atopy.

Conclusion: The central role of Fcε RIβ in atopy and the linkage data presented here point to the possibility that genetic variation in Fcε RIβ or its controlling element may cause differences in the extent of IgE responses between atopic and non‐atopic subjects. A search for such mutations or polymorphisms will need to take into account some carriers of atopy among the normal population and genetic heterogeneity among atopic individuals.
Impaired IgG responses in a child with homozygous C2 deficiency and recurrent pneumococcal septicaemia
Authors: Attwood JT , Williams Y , Feighery C
Published: August 2010

Homozygous deficiency of the second component of complement (C2) is the most common inherited deficiency of complement (1). Although C2 deficiency has been detected in asymptomatic individuals, patients usually present with either autoimmune disease or recurrent pyogenic infection, particularly due to encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae type b and Neisseria meningitidis. Interestingly, infection is the most common mode of presentation of C2 deficiency in young children (1). An association between C2 deficiency and IgG subclass deficiency has also been previously described (2–4). We now report a female child with C2 deficiency that presented at the age of 3 mo with recurrent pneumococcal septicaemia. Although IgG subclass levels were normal, specific IgG responses to vaccination against S. pneumoniae and H. influenzae were significantly impaired.
Plasma levels of natriuretic peptides and hemodynamic assessment of patent ductus arteriosus in preterm infants
Authors: Holmström H , Hall C , Thaulow E
Published: August 2010

The main purpose of this study was to investigate whether circulating natriuretic peptides in premature infants reflect the hemodynamic significance of a patent ductus arteriosus (PDA). The study comprises 120 examinations in 55 premature infants with a mean gestational age of 27.2 wk and a mean birthweight of 933 g. Based on clinical and echocardiographic findings, the hemodynamic influence of ductal shunting was classified as small, moderate or large. Blood samples for N‐terminal proatrial natriuretic peptide (Nt‐proANP) and brain natriuretic peptide (BNP) were analysed after completion of the clinical part of the study. Linear regression indicated a very strong association between Nt‐proANP and BNP (adjusted R2= 0.89). The mean levels of Nt‐proANP and BNP increased with the size of the shunt through a PDA, and peptide values followed hemodynamic alterations. The size of PDA accounted for 50% and 47% of the total variation in the plasma values of Nt‐proANP and BNP, respectively. In detecting an echocardio‐graphically significant PDA, the area under a ROC curve was 0.94 for Nt‐proANP and 0.90 for BNP.

Conclusion: The magnitude of shunting through a PDA is the main determinant of plasma levels of natriuretic peptides in premature infants. Nt‐proANP and BNP seem to have the same pattern of secretion. Our findings indicate that measurements of natriuretic peptides may provide clinically relevant information in the hemodynamic assessment of premature infants.
Tumor‐ and treatment‐related side effects after multimodal therapy of childhood intracranial germ cell tumors
Authors: Benesch M , Lackner H , Schagerl S , Gallistl S , Frey E‐M , Urban C
Published: August 2010

Multimodality treatment approaches have dramatically improved the outcome of patients with intracranial germ cell tumors and are resulting in an increasing number of long‐term survivors. The aim of the present study was to evaluate prospectively the development of side effects in children, adolescents and young adults after treatment for intracranial germ cell tumors. Nine patients with a median age of 14 y at diagnosis and a median follow‐up of 7.25 y underwent a detailed long‐term evaluation including physical and neuro‐ophthalmologic examinations, routine laboratory and endocrine stimulation tests, neuropsychometric testing, audiometry and spirometry at repeated intervals. Endocrine deficiencies requiring hormone replacement therapy occurred in all patients. Neuro‐ophthalmologic side effects were observed in 8 of the 9 patients, urinary electrolyte wasting in 4 of the 9, alopecia in 3 of the 9 and high‐frequency hearing loss in 2 of the 9. Neuropsychologic examinations revealed pathologic results in all five tested patients.

Conclusion: The present study indicates that former intracranial germ cell tumor patients suffer from remarkable long‐term side effects, and that some of these late effects can develop or worsen months or years after cessation of oncologic therapy. Since life quality is an important parameter of cancer survival, careful follow‐up of long‐term survivors is mandatory, aimed at counteracting side effects as early as possible and therefore at minimizing long‐term morbidity, which may considerably compromise quality of life.
Determinants of stunting at 6, 12, 24 and 60 months and postnatal linear growth in Pakistani children
Authors: Saleemi MA , Ashraf RN , Mellander L , Zaman S.
Published: August 2010

A “nested” case‐control design was used to identify cases from a longitudinally followed cohort of 1236 newborns registered during 1984–1987, living in three socioeconomically different areas. The children had a length <–2SDS (standard deviation scores) at 6, 12, 24 and 60 mo of age using the NCHS reference. The controls were matched for gender, area and month of birth. A logistic regression analysis was used for determining the risk factors for stunting at each age. Postnatal linear growth was also examined in these two groups of children and body size was compared with the NCHS reference and that of upper‐middle‐class children (n= 240). At 6 mo of age, prematurity and duration of breastfeeding showed a significant association with stunting. At 12 mo, maternal height, birthweight and stunting at 6 mo, while at 24 mo, stunting at 6, 12 and 18 mo were identified as important factors. At 60 mo, no other factors besides previous stunting could be identified. The mean height reached at 60 mo showed a deficit of 6 and 13 cm for the controls and the cases, respectively, compared to the NCHS reference. Twenty‐eight percent of the children from the two poor areas who were stunted at 6 mo had improved by 60 mo of age.

Conclusion: The risk factors for stunting varied at different ages, relating more to feeding at early ages and to previous stunting, predominantly at higher ages. The linear growth showed that faltering increased with age when cases and controls were treated separately. Recovery from stunting could also be demonstrated.
Hyperimmune bovine colostrum in the treatment of shigellosis in children: a double‐blind, randomized, controlled trial
Authors: Ashraf H , Mahalanabis D , Mitra AK , Tzipori S , Fuchs GJ
Published: August 2010

Immunological approaches have been considered as an alternative therapeutic option for the treatment of enteric infections over the past few years. Hyperimmune bovine colostrum (HBC) is a potentially innovative immunological option in the management of shigellosis together with traditional antibiotic therapy. Children aged 1‐12 y with a history of bloody mucoid diarrhoea of less than 5 d duration were enrolled after their stool specimen was found to be positive for Shigella dysenteriae type 1 antigen by a rapid diagnostic fluorescent antibody staining test. They were randomized to receive either HBC containing very high titres of antibody against S. dysenteriae type 1 antigen or bovine colostrum (BC) without any antibody. The study group received 100ml of HBC three times a day orally for 3 d and control group received BC. Children also received pivmecillinam in a dose of 50mg kg−1 d−1 in four divided doses orally for 5 d. Admission characteristics of the 34 children in the HBC group and 35 in the BC group were comparable. No significant differences were observed in duration of diarrhoea, fever, anorexia, abdominal pain, tenesmus, stool frequency or visible blood in the stool between the groups. Two (6%) children in the study and five (14%) in the control group remained stool culture positive for S. dysenteriae type 1, even after 5 d of sensitive antimicrobial therapy.

Conclusion: The results indicate that HBC as an adjuvant is unable to show any beneficial effect in reducing the stool frequency, duration or severity of childhood shigellosis due to S. dysenteriae type 1 infection.
Development of sucking behavior in infants with Down's syndrome
Authors: Mizuno K , Ueda A
Published: August 2010

The aim of this study was to gain a better understanding of the development of sucking behavior in infants with Down's syndrome. The sucking behavior of 14 infants with Down's syndrome was consecutively studied at 1, 4, 8 and 12 mo of age. They were free from complications that may cause sucking difficulty. The sucking pressure, expression pressure, frequency and duration were measured. In addition, an ultrasound study during sucking was performed in sagittal planes. Although levels of the sucking pressure and duration were in the normal range, significant development occurred with time. Ultrasonographic images showed deficiency in the smooth peristaltic tongue movement.

Conclusion: The sucking deficiency in Down's syndrome may result from not only hypotonicity of the perioral muscles, lips and masticatory muscles, but also deficiency in the smooth tongue movement. This approach using the sucking pressure waveform and ultrasonography can help in the examination of the development of sucking behavior, intraoral movement and therapeutic effects.
Hearing impairment in preterm very low birthweight babies detected at term by brainstem auditory evoked responses
Authors: Jiang ZD , Brosi DM , Wilkinson AR
Published: August 2010

Seventy preterm babies who were born with a birthweight <1500 g were studied with brainstem auditory evoked responses (BAER) at 37‐42 wk of postconceptional age. The data were compared with those of normal term neonates to determine the prevalence of hearing impairment in preterm very low birthweight (VLBW) babies when they reached term. The BAER was recorded with click stimuli at 21 s−1. Wave I and V latencies increased significantly (ANOVA p < 0.01 and 0.001). I‐V and III‐V intervals also increased significantly (p < 0.05 and 0.001). Wave V amplitude and V/I amplitude ratio did not differ significantly from those in the normal term controls. Ten of the 70 VLBW babies had a significant elevation in BAER threshold (>30 dB normal hearing level). Eleven had an increase in I‐V interval (>2.5 SD above the mean in the normal controls) and one had a decrease in V/I amplitude ratio (<0.45). These results suggest that 14% (10/70) of the VLBW babies had a peripheral hearing impairment and 17% (12/70) a central impairment. Three babies had both an increase in I‐V interval and an elevation in BAER threshold, suggesting that 4% (3/70) had both peripheral and central impairments. Thus, the total prevalence of hearing impairment was 27% (19/70).

Conclusion: About one in four preterm VLBW babies has peripheral and/or central hearing impairment at term. VLBW and its associated unfavourable perinatal factors predispose the babies to hearing impairment.
Body mass index reference values (mean and SD) for Swedish children
Authors: Karlberg J , Luo ZC , Albertsson‐Wikland K
Published: August 2010

Body mass index (BMI) is an important indicator of nutritional status. Many studies have been done to present BMI reference values in centile values rather than mean and SD values since its statistical distribution is positively skewed. Both height and weight growth charts are usually available in terms of mean and 1, 2 and 3 SD around the means; it would be of clinical value to produce BMI reference charts in a similar way. The aim of this work was to derive the mean and ±1, 2 and 3 SD BMI reference ranges as a supplement to the BMI centile reference values published previously for the same group of Swedish children. The method was based on an age‐dependent Box transformation, and the β‐value was given as a third‐degree polynomial function over the paediatric age. The BMI reference values can be given from mathematical functions in addition to values for specific ages.

Conclusion: The BMI reference values and charts derived as described effectively reflect the nature of the variant age‐dependent positive skewed statistical distribution of BMI values in the population, and can serve as a valid supplementary tool in the evaluation of growth and nutrition during paediatric years.
Patient‐triggered ventilation in premature neonates
Authors: Baumer JH
Published: August 2010

Observed short‐term benefits of patient‐triggered ventilation include improvements in oxygenation and carbon dioxide elimination, reduced cerebral blood flow variability, more rapid weaning from ventilation and reduced adrenaline levels. The three multicentre randomized controlled trials in which longer term outcomes were investigated failed to demonstrate any consistent reductions in rates of pneumothorax, chronic lung disease, cranial ultrasound changes, duration of ventilation or mortality. Two of these studies were conducted wholly or predominantly using the SLE 2000 ventilator, with the Drager Babylog 8000 used in a minority of infants. The results therefore reflect only the performance of these ventilators, with the ventilation techniques used. As the degree to which synchrony was achieved was not measured in any of these studies, they provide no evidence for a lack of benefit from achieving synchronous ventilation. It is possible that the findings were influenced by the use of drugs, especially morphine and theophylline. In one study the pneumothorax rate was significantly lower in infants recruited within 3 mo of the first patient enrolled at that centre, and was seen with both modes of ventilation. This suggests that staff education in ventilation techniques may be important in reducing pneumothorax rates.
The efficacy of bismuth subsalicylate in the treatment of acute diarrhoea and the prevention of persistent diarrhoea
Authors: Chowdhury HR , Yunus M , Zaman K , Rahman A , Faruque SM , Lescano AG , Sack RB
Published: August 2010

A controlled, randomized, double‐blind study in Bangladeshi children (ages 4–36 mo) with acute diarrhoea was undertaken to determine whether bismuth subsalicylate (BSS) would prevent the development of persistent diarrhoea (PD) in young children. The children were randomized to two groups: 226 were given liquid oral BSS, (as Pepto‐Bismol), 100mg/kg/d for 5 d; 225 were given placebo of identical appearance. On admission to the study, the two groups were comparable both clinically and microbiologically. Rotavirus was found in 56% of all the children, and enterotoxigenic E. coli in 31% of a subsample studied. Children treated with BSS had less severe and less prolonged illness than those treated with placebo (p= 0.057). There was, however, no difference in the development of PD between the two groups (8% and 11%). Unexpectedly, patients treated with BSS gained significantly more weight (2.3%) than those treated with placebo (0.5%; p < 0.001) during the course of the study. No toxicity of BSS was detected.

Conclusion: Treatment with BSS had a modest therapeutic effect on acute diarrhoea, as has been previously demonstrated, but with no suggestion of a therapeutic effect on the prevention of persistent diarrhoea in this group of patients.
Shorter PFA‐100® closure times in neonates than in adults: role of red cells, white cells, platelets and von Willebrand factor
Authors: Roschitz B , Sudi K , Köstenberger M , Muntean W
Published: August 2010

In neonates, despite poor platelet function in various in vitro tests, closure times (CTs) in PFA‐100 measurements are shorter than in adults. Neonates have a higher polymeric von Willebrand factor (vWF). They also have a higher haematocrit and higher white blood cell count than adults, which may interfere with the evaluation of platelet and vWF function by means of the PFA‐100 in neonates. To assess the role of different blood constituents on neonatal CTs, red blood cell, platelet and white blood cell counts in cord blood were modified. These modifications did not provide any evidence that the difference in number between adult and neonatal blood cells was responsible for shorter neonatal CTs. In further experiments, platelets and/or vWF were inhibited by means of abciximab and anti‐vWF antibody, and mixing experiments with neonatal platelet‐rich and platelet‐poor plasma were performed. The results showed that short cord blood PFA‐100 CTs were caused by a constituent of neonatal platelet‐poor plasma, probably the neonatal high multimeric vWF.

Conclusion: This study demonstrates that CTs in neonates are dependent on the same components, platelets and vWF, as in adults, making it likely that the PFA‐100 can be used in neonates in the same way as in adults to investigate platelet and vWF function.
The breech presentation and the vertex presentation following an external version represent risk factors for neonatal hip instability
Authors: Andersson JE , Oden A
Published: August 2010

The aim of this study was to evaluate the frequency and type of hip‐joint instability and the frequency of hip dislocation requiring treatment in neonates who had been lying in the breech presentation and were delivered vaginally after an external version or by caesarean section, and to compare them with neonates who were naturally in the vertex presentation. Breech presentations without ongoing labour were subjected to an attempted external version and, in cases where this proved unsuccessful or where labour had started, to deliver by caesarean section. None of the breech presentations was vaginally delivered. The anterior‐dynamic ultrasound method was used to assess the hip‐joint status of the neonates. Out of 6571 foetuses, 257 were in breech presentation after 36 wk of pregnancy. Sixty‐two were vaginally delivered following an external version to vertex presentation and 195 were delivered by caesarean section, 75 of these following unsuccessful attempts to perform a version. Treatment for congenital hip‐joint dislocation was performed on 0.2%. Out of the breech presentations, 1.0% of those delivered by caesarean section were treated, while in those with vaginal delivery following an external version the treatment frequency was 3.2%. No case of late diagnosed hip dislocation was recorded. Significant differences in frequency of hip‐joint instability and treatment were found between (i) neonates delivered in breech presentation and those delivered with vertex presentation, (ii) infants delivered in vertex presentation, naturally or after successful version, and (iii) those delivered by caesarean section with or without attempted external version and those delivered with vortex presentation.

Conclusion: Breech presentation predisposes to increased hip instability. The instability is present prior to delivery and is certainly not a primary result of delivery forces. Both breech and vertex presentations following an external or spontaneous version should be considered as risk factors for neonatal hip instability.
Adverse events following vaccination in premature infants
Authors: Sen S , Cloete Y , Hassan K , Buss P
Published: August 2010

The aims of this study were to study the frequency, severity and types of adverse reactions following DPT/Hib (diphtheria and tetanus toxoids and pertussisHaemophilus influenzae type B conjugate) immunization in very preterm infants and to identify possible risk factors. Case notes of 45 preterm babies vaccinated in the neonatal intensive care unit between January 1993 and December 1998 were studied retrospectively. Birthweight, gestational age, duration of ventilation, oxygen dependency, timing of vaccination, weight, corrected gestation at vaccination and apparent adverse effects were noted. Apparent adverse events were noted in 17 of 45 (37.8%) babies: 9 (20%) had major events, i.e. apnoea, bradycardia or desaturations, and 8 (17.8%) had minor events, i.e. increased oxygen requirements, temperature instability, poor handling and feed intolerance. Babies with major events were significantly younger (p<0.05), had a lower postmenstrual age (p < 0.05) and weighed less (p< 0.05) at the time of vaccination compared with babies without major events. No differences in the mean birthweight, gestational age, duration of ventilation or oxygen dependency were found between the two groups. Age at vaccination of 70 days or less was significantly associated with increased risk (p < 0.01). Of 27 babies vaccinated at 70 days or less, 9 (33.3%) developed major events compared with none when vaccinated over 70d.

Conclusion: Vaccine‐related cardiorespiratory events are relatively common in preterm babies. Problems were much more common if vaccine is administered at or before 70 d. These babies should therefore be monitored postvaccination. Further prospective studies are needed to clarify whether delaying vaccination offers protection against these adverse events.
Breast milk from mothers of very low birthweight infants: variability in fat and protein content
Authors: Weber A , Loui A , Jochum F , Bührer C , Obladen M
Published: August 2010

While breast milk appears to be superior to formula for the development of very low birthweight (VLBW) infants, it is supplemented to meet the metabolic demands of the rapidly growing premature infant. To estimate the nutritional variability of breast milk from mothers of VLBW infants, protein (bicinchoninic acid method) and fat content (creamatocrit) were measured in breast‐milk spot samples from mothers of 20 VLBW infants, collected 4 times a day during the first 4 wk of lactation Protein content (median 1.9 g dl−1, range 1.1–3.5 g dl−1) and fat content (3.8/1.0–14.6 g dl−1) were highly variable and lacked a normal distribution over all samples and in individual women's milk. There was only a weak correlation between fat and protein (rs= 0.416, p < 0.001). Fat but not protein was lower in morning samples than in samples collected later in the day (p < 0.001). Protein but not fat content decreased during the weeks of lactation (rs=−0.446, p < 0.001). No impact of the baby's gestational age was observed.

Conclusion: The fat and protein content of breast milk from mothers of VLBW infants is highly variable, calling into question the clinical feasibility of individualized supplementation of breast milk for VLBW infants based on spot sample measurements.
Vitamin C is reduced in human milk after storage
Authors: Buss IH , McGill F , Darlow BA , Winterbourn CC
Published: August 2010

In order to establish how cold storage of human milk affects levels of bioavailable vitamin C, 11 samples were stored for 24 h in the refrigerator or up to 2 mo in the freezer. Total vitamin C levels decreased on average by one‐third in the refrigerator or after 1 mo of freezing, with wide variations between individuals (6 to 76% and 3 to 100%, respectively). After 2 mo of freezing, the average decrease was two‐thirds (7–100%).

Conclusion: We recommend a change in human milk storage practices, to under 24 h in a refrigerator or under 1 mo in a freezer. Alternatively, vitamin C supplementation may be considered.
Bone mineral content and collagen metabolites in children receiving steroid treatment for nephrotic syndrome
Authors: Esbjörner E , Arvidsson B , Jones IL , Palmér M
Published: August 2010

Bone mineral density (BMD) and content (BMC) were measured in nine children treated with corticosteroids for nephrotic syndrome and in age‐matched controls, using dual‐energy X‐ray absorptiometry (DEXA). The urinary excretion of cross‐linked N‐telopeptide (NTx) released from collagen type I as a specific marker of bone resorption was also measured. There were no significant differences in body size, BMD results or NTx urinary concentrations between patients and controls, nor could any significant differences be found when the six patients given a cumulative corticosteroid dose of < 15 g were analysed separately. The lack of significant differences could be due to the small number of patients included in the study. But when the measured BMD and BMC were analysed according to methods that corrected for body size and puberty stage, values well within the normal range were found in patients as well as in controls. There was, however, a significant, negative correlation between the urinary excretion of NTx and the cumulative dose of corticosteroids.

Conclusion: Despite treatment for long periods with high, cumulative doses of corticosteroids, the skeletons of the patients had a normal mineral content, which is encouraging for all those in need of steroids for nephrotic syndrome. A negative correlation between urinary collagen degradation products and the cumulative steroid dose might point to a reduced growth velocity in patients on high doses of steroids earlier than an effect on bone mineralization.
Bibliometric data: a disaster for many non‐American biomedical journals
Authors: Zetterström R
Published: August 2010

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Pœdiatrica, has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American‐oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non‐American research, it is important that no single super‐power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.
Exhaled and nasal nitric oxide in mechanically ventilated preterm and term newborns
Authors: Aikio O , Pokela ML , Hallman M
Published: August 2010

Aim: Nitric oxide (NO) is an important mediator required for neonatal pulmonary circulatory adaptation and for pulmonary defence. Both deficient and excessive NO production have been proposed to play a role in neonatal lung disease. This study aimed to establish a method that allows direct measurement of exhaled and nasal NO concentrations in newborn infants who require intubation and ventilation.Methods: A rapid‐response chemiluminescence NO analyser was used. Gas was sampled from the endotracheal intubation tube, and tidal volumes and flow rates were measured. The nasal NO was sampled from the non‐intubated nostril. The accuracy of the method was validated using a lung model. NO levels from six preterm and six term/near‐term newborns were studied. Measurements were performed on a daily basis during the first week.Results: An expiration >0.2 s in duration with a flow rate >1.7mls−1could be accurately analysed for the presence of >1 parts per billion of NO. The very preterm infants with neonatal lung disease had a different postnatal NO output pattern from the lower and upper airways compared with the ventilated term/near‐term infants.

Conclusion: A novel method for measurement of exhaled NO of an intubated newborn is presented. The possible association of exhaled NO concentration with the development of chronic lung disease remains to be studied.
Effects of gender, apolipoprotein E phenotype and cholesterol‐lowering by plant stanol esters in children: The STRIP study
Authors: Tammi A , Rönnemaa T , Miettinen TA , Gylling H , Rask‐Nissilä L , Viikari J , Tuominen J , Marniemi J , Simell O
Published: August 2010

Aim: To evaluate the effects of gender, apolipoprotein E phenotype and cholesterol absorption and synthesis (estimated as serum plant sterol and cholesterol precursor sterol concentrations) on the cholesterol‐lowering effect of plant stanol esters in children. Methods: Eighty‐one healthy, normocholesterolaemic 6‐y‐old children (45 boys) were recruited from the Special Turku Coronary Risk Factor Intervention Project (STRIP), a randomized prospective trial aiming at atherosclerosis prevention in childhood. This placebo‐controlled, double‐blind, cross‐over study comprised two 3‐mo study periods and a 6‐wk wash‐out period. During the study periods, 20 g of the children's daily dietary fat intake was replaced with plant stanol ester margarine or control margarine. Results: In boys, plant stanol esters reduced serum total and low‐density lipoprotein cholesterol concentrations by 6% (0.09 to 0.42mmol/L) and 9% (0.09 to 0.36mmol/L), respectively (p > 0.01 for both). In girls, the decreases in concentrations were 4% (0.03 to 0.38 mmol/L) and 6% (0.02 to 0.32 mmol/1) (p > 0.05 for both). The response rate did not differ between the genders. Serum total and low‐density lipoprotein cholesterol concentrations decreased by 6% and 8% (p > 0.01 for both), respectively, in both children with the apolipoprotein E 3/4 or 4/4 (apoE4+) phenotype and the apolipoprotein E 2/3 or 3/3 (apoE4—) phenotype. Cholesterol absorption decreased both in the apoE4+ children and in the apoE4— children, but cholesterol synthesis consistently increased in the apoE4+ children only.

Conclusion: Plant stanol esters reduce serum cholesterol concentration in healthy children irrespective of their gender or apoE4 phenotype.
Pathogenesis of retinopathy of prematurity
Authors: Smith LEH
Published: August 2010

Retinopathy of prematurity (ROP) is a blinding disease, initiated by delayed retinal vascular growth after premature birth. There are both oxygen‐regulated and non‐oxygen‐regulated factors, which contribute to both normal vascular development and retinal neovascularization. One important oxygen‐regulated factor, critical to both phases of ROP, is vascular endothelial growth factor (VEGF). A critical non oxygen‐regulated growth factor is insulin‐like growth factor (IGF‐1). In knockout mice, lack of IGF‐1 prevents normal retinal vascular growth, despite the presence of VEGF, important to vessel development. In vitro, low IGF‐1 prevents vascular endothelial growth factor‐induced activation of Akt, a kinase critical for vascular endothelial cell survival. Premature infants who develop ROP have lower levels of serum IGF‐1 than age‐matched infants without disease.

Conclusion: IGF‐1 is critical to normal vascular development. Low IGF‐1 predicts ROP and restoration of IGF‐1 to normal levels may prevent ROP.
Craniofacial morphology in preschool children with sleep‐related breathing disorder and hypertrophy of tonsils
Authors: Kawashima S , Peltomäki T , Sakata H , Mori K , Happonen R‐P , Rönning O
Published: August 2010

The purpose of this study was to examine craniofacial morphology, pharyngeal airway space and hyoid bone position in preschool children with sleep‐related breathing disorder associated with hypertrophy of tonsils (SBDT). Thirty‐eight preschool children, mean age 4.7 y, with SBDT and with an apnoea index (AI) of 0 < AI <5, were divided into two groups. One consisted of 15 children with sleep‐related breathing disorder (SBD) and more than 75% of the tonsils visible (GUI) and the other of 23 children with SBD and 25–75% of the tonsils visible (Gil). The control group consisted of 31 children without ear, nose and throat disease and with GI (barely visible) tonsils. Compared with the controls, GUI children had a retrognathic mandible, a large posterior facial height, a large interincisal angle with retroclined lower incisors, a narrow pharyngeal airway space, an anterior tongue base position and a long soft palate. Compared with the controls, Gil children had a large anterior lower facial height and a short nasal floor. However, like the controls, Gil children did not have a retrognathic mandible.

Conclusion: The findings show that children with SBDT display a characteristic facial appearance at an early age. Since the condition has an effect on growth, it needs to be prevented by controlling morphology and function at the preschool age.