bluuebunny/crossref_metadata_2025 huggingface dataset:
Inflammatory pathways between placenta and foetus
Authors: Hallman Mikko
Published: August 2010

Recent evidence indicates that intra‐amniotic endotoxin (LPS) and interleukin‐1 alpha (IL‐1α) accelerate foetal lung maturity and protect from respiratory distress syndrome (RDS) more effectively than does antenatal glucocorticoid. Inflammatory cytokines promote development of chronic lung disease in the premature, acute RDS (ARDS) in children and adults. Systemic exposure to LPS or cytokines can result in generalized multiorgan damage. The abnormal host defence in the foetus and the premature newborn need to be considered in therapeutic interventions.
Recurrent abdominal pain, food allergy and endoscopy
Authors: Husby Steffen , Høst Arne
Published: August 2010

Gastrointestinal food allergy, a well‐recognized clinical entity, has a wide spectrum of clinical features, including cutaneous, respiratory and gastrointestinal symptoms and objective abnormalities. The gastrointestinal alterations in food allergy have been described throughout the gastrointestinal tract. Recurrent abdominal pain (RAP) is a common complaint in school‐age children. The findings among children with RAP of an underlying food allergy associated with mucosal pathology of the foregut may support a causal relationship between food allergy and RAP. Further studies are needed to elucidate whether well‐documented food allergy (based on double‐blind placebo‐controlled food challenges) is a major cause of RAP.
Mucosal pathology of the foregut associated with food allergy and recurrent abdominal pains in children
Authors: Kokkonen J , Ruuska T , Karttunen TJ , Niinimäki A
Published: August 2010

To determine whether children with recurrent abdominal pain (RAP) include an excess of children with food allergy (FA), this study examined a consecutive series of 84 children (43M, 41F, mean age 7.9 y, range 1.6–15 y) referred during 1 y to 2 university hospitals. In addition to a clinical examination, the patients underwent gastroduodenoscopy with three biopsy specimens, skin‐prick and patch tests, and comprehensive laboratory tests for atopic allergy. Based on an open elimination‐challenge test, a total of 28 (33%) subjects were diagnosed for FA. In the whole material, specific endoscopic abnormalities were found in 38 (45%) subjects: oesophagitis in 17, gastric erosions in 8, lymphonodular duodenitis in 12 and erosive duodenitis in 5. FA showed a close relationship with duodenal lesions, but no significant association with oesophagitis and gastritis. The histological findings were mild, although some alterations could be observed in up to 66 (79%) subjects, equally often in patients with and without FA. None showed villous atrophy or severe infiltration of eosinophilic or mononuclear cells. Slightly increased densities of eosinophilic cells were significantly associated with endoscopic findings, especially oesophagitis. At least one positive skin‐prick test with food allergens was found in 11 subjects and a positive patch test in 21 subjects, but neither showed an association with the endoscopic or histological findings, or even with clinical FA.

Conclusion:Since the children with FA showed significantly more often concomitant mucosal pathology of the foregut than those without FA, FA may be considered one of the major factors underlying RAP. The report suggests the trial of an elimination diet in cases with RAP if lymphonodular hyperplasia or duodenitis is seen on gastroduodenoscopy.
Maternal cannabis use in the sudden death syndrome
Authors: Scragg RKR , Mitchell EA , Ford RPK , Thompson JMD , Taylor BJ , Stewart AW
Published: August 2010

The smoking of cannabis and tobacco is common in many countries. In contrast to tobacco, which is an established risk factor for the sudden infant death syndrome (SIDS), nothing is known about cannabis and its effects on SIDS risk. We analysed data collected in a nation‐wide case control study in New Zealand (393 cases, 1592 controls) to determine if there is any association between maternal cannabis use and SIDS risk. Adjusting for ethnicity and maternal tobacco use, the SIDS odds ratio for > weekly maternal cannabis use since the infant's birth was 2.23 (95% CI = 1.39, 3.57) comparedto non‐users; and the multivariate odds ratio was 1.55 (95% CI = 0.87, 2.75).

We conclude that frequent maternal cannabis use may be a weak risk factor for SIDS, but this finding requires further research.
Intra‐amniotic endotoxin accelerates lung maturation in fetal rabbits
Authors: Bry Kristina , Lappalainen Urpo
Published: August 2010

The hypothesis that endotoxin in amniotic fluid accelerates fetal lung maturation was tested. On day 25 of gestation, LPS (5 μg/fetus) was injected intra‐amniotically into one uterine horn of eight New Zealand white rabbits, whereas the contralateral amniotic sacs were injected with saline vehicle. The fetuses were delivered 48 h after LPS administration and their lungs were studied. One dam went into premature labor prior to the 48 h time point and was excluded from the study. Mean white cell counts in amniotic fluid and bronchoalveolar lavage fluid from LPS‐treated fetuses were increased 3.2‐fold (p= 0.04) and 9.9‐fold (p= 0.04), respectively. Fetal weights and lung weights were not affected by LPS. Surfactant protein SP‐A and SP‐B mRNA expressions in LPS‐treated fetuses were increased 2.3‐fold (p= 0.03) and 1.4‐fold (p= 0.04), respectively. Static lung compliance was increased in animals treated with LPS (p= 0.001). Lungs from LPS‐treated animals had better aeration than those of controls. Mean volume of inflation‐fixed lungs of LPS‐treated fetuses was 1.7 times greater than that of controls (p= 0.03).

Conclusion: Intra‐uterine exposure to LPS increases surfactant protein expression and improves lung stability and aeration in preterm animals.
Aetiological factors in neonatal cholestasis
Authors: Fischler B , Papadogiannakis N , Nemeth A
Published: August 2010

The aim of the study was to investigate factors of possible importance for the aetiology of neonatal cholestasis. The medical records of 85 cholestatic infants were retrospectively reviewed. The most common diagnoses were extrahepatic biliary atresia (n= 30 patients), α1‐antitrypsin deficiency (n= 11) and progressive familial intrahepatic cholestasis (n= 11). The mothers of the patients with biliary atresia had a higher mean age and were more commonly treated for gestational diabetes than the mothers of patients with intrahepatic neonatal cholestasis. The morbidity and mortality in the siblings of patients with biliary atresia were also greater than expected. There was a seasonal variation of the birth months in the biliary atresia group, possibly indicating an association to viral infections. Signs of ongoing cytomegalovirus infection were more common in both the extrahepatic and the intrahepatic group.

Conclusions: Progressive familial intrahepatic cholestasis may be a more common cause of neonatal cholestasis in Sweden than reported elsewhere. A maternal vulnerability, of genetic or other origin, is suggested in the aetiology of biliary atresia. The true pathogenetic importance of cytomegalovirus infection in patients with neonatal cholestasis of different origins remains to be established.
Importance of insulin content in infant diet: suggestion for a new infant formula
Authors: Shehadeh N , Gelertner L , Blazer S , Perlman R , Solovachik L , Etzioni A
Published: August 2010

Oral insulin promotes intestinal maturation and may prevent diabetes in animal models. The aim of this study was to evaluate the concentration of insulin in human milk and in different infant formulas. Our results show that the concentration of insulin in human milk is significantly higher (60.23 ± 41.05 μU/ml mean ± SD) compared with cow's milk (16.32 + 5.98 μU/ml mean ± SD) and that insulin is hardly detectable in infant formulas.

We propose the addition of human insulin to infant formula to match its composition more closely to human milk.
Hydrolysed protein accelerates the gastrointestinal transport of formula in preterm infants
Authors: Mihatsch WA , Högel J , Pohlandt F
Published: August 2010

Vomiting, large gastric residuals and abdominal distension are common in very immature infants on formula feeding. The present trial investigated whether a protein hydrolysate formula reduces the gastrointestinal transit time in preterm infants. Fifteen preterm infants (median gestational age 29 (24–32) wk, birthweight 1241 (660–1900) g, postnatal age 18 (5–54) d) on full enteral feeds (>150 ml/kg*d) were enrolled. It was hypothesized that the gastrointestinal transit time is at least 2 h shorter when protein hydrolysate formula is fed compared with standard preterm formula. In a randomized cross‐over design study, each formula was fed for 5 d. On days 4 and 9 the gastrointestinal transit time was estimated using carmine red. The protein hydrolysate formula had a markedly shorter gastrointestinal transit time (9.8 h) than the standard formula (19 h) (p= 0.0022, two‐sided Mann‐Whitney U test).

Conclusion: The hydrolysate protein formula accelerated gastrointestinal transit of milk and stools, but whether hydrolysate formulas enable a more rapid establishment of full enteral feeding in preterm infants needs to be investigated.
Limiting light‐induced lipid peroxidation and vitamin loss in infant parenteral nutrition by adding multivitamin preparations to Intralipid
Authors: Silvers KM , Sluis KB , Darlow BA , McGill F , Stocker R , Winterbourn CC
Published: August 2010

Parenteral lipids are susceptible to light‐induced peroxidation, particularly under phototherapy. Ascorbic acid is protective. The aim of this study was to investigate whether dark delivery tubing and/or coadministration of multivitamin preparations could prevent peroxidation of Intralipid without undue vitamin loss. In experiments carried out on the benchtop, lipid peroxidation occurred in ambient light and was more extensive under phototherapy. Dark tubing decreased peroxide formation, but only by about 65%. In simulated clinical conditions in which solutions were pumped through standard clear or dark minibore plastic tubing, Intralipid accumulated lipid peroxides as measured by the FOX assay (280 μM) or as triglyceride hydroperoxides (52 μM). Multivitamin preparations (MVIP or Soluvit/Vitlipid) inhibited peroxide formation almost completely, and were fully protective when used with dark tubing. There was loss of riboflavin (65% from Soluvit and 35% from MVIP) in clear tubing but this was decreased to 18% and 11%, respectively, in dark tubing. Ascorbate loss was 20% (MVIP) and 50% (Soluvit) and only slightly less in dark tubing. Ascorbate loss was also seen in the absence of Intralipid and is due to riboflavin‐induced photo‐oxidation.

Conclusion: Multivitamin preparations protect Intralipid against light‐induced formation of lipid hydroperoxides, and administering multivitamins with Intralipid via dark delivery tubing provides a practical way of preventing peroxidation of the lipid while limiting vitamin loss. This procedure should be considered for routine use as well as with phototherapy.
The balance of the autonomic nervous system is normal in colicky infants
Authors: Kirjavainen J , Jahnukainen T , Huhtala V , Lehtonen L , Kirjavainen T , Korvenranta H , Mikola H
Published: August 2010

Excessively crying, hard‐to‐soothe infants are described as colicky. The self‐limiting course of infantile colic during early infancy suggests an etiology of transient developmental dysmaturation. It has been proposed that emotional characteristics such as temperament and self‐soothing ability are correlated with the balance of the autonomic nervous system. Heart rate variability (HRV) analysis was used for evaluating the balance of the autonomic nervous system in colicky and control infants during and after the colicky period. HRV analysis was carried out on 12 colicky infants and 14 control infants at the age of 2 mo, and repeated on 10 colicky and 11 normal infants at the age of 7 mo. Measurements were performed during polygraphically confirmed slow‐wave sleep (sleep stages 3 and 4). Three HRV frequency bands were defined, including a high (0.2–1.0 Hz), middle (0.12–0.2 Hz) and low (0.025–0.12 Hz) frequency variability. There were no differences between the study groups in any of the three HRV frequency bands analyzed. The high frequency variability increased significantly with age in both study groups (p= 0.009).

Conclusion: The findings suggest that imbalance between the parasympathetic and the sympathetic nervous system is not associated with infantile colic and that, in accordance with previous findings, control of HRV shifts in a parasympathetic direction with increasing age during the first year of life.
Antenatal magnesium sulphate exposure is associated with prolonged parathyroid hormone suppression in preterm neonates
Authors: Rantonen T , Kääpä P , Jalonen J , Ekblad U , Peltola O , Välimäki I , Kero P
Published: August 2010

The effects of maternal magnesium sulphate treatment on neonatal mineral status and parathyroid hormone secretory response were studied in 8 exposed and 27 control preterm infants during the first 2 wk of life. Antenatal magnesium sulphate resulted in hypermagnesaemia during the first 3–7 d of life without affecting other serum mineral concentrations.

Conclusion: Early hypermagnesaemia was associated with hypercalciuria during the first 3 d and parathyroid hormone suppression up to the age of 2 wk in the exposed infants.
Evaluation of a language‐screening programme for 2.5‐year‐olds at Child Health Centres in Sweden
Authors: Mattsson C Miniscalco , Mårild S , Pehrsson NG
Published: August 2010

A population‐based language‐screening programme started in the western part of Sweden (South Bohuslän) in 1991, with the aim of identifying developmental language disability in 2.5‐y‐old children. The programme was evaluated during 1998 in an experimental study. A group of 105 2.5‐y‐old children was recruited from 24 separate Child Health Centres. A sample of 25 children with a positive screening result was selected. For each of the 25 children, 1–4 controls, i.e. children with a negative screening result, were selected. The results were reclassified blindly by three speech and language therapists and used as a gold standard. Positive and negative predictive values were estimated to be 0.52 (95% confidence interval 0.31–0.72) and 0.96 (95% confidence interval 0.89–0.99), respectively. Baye's theorem was used to calculate the sensitivity (0.69) and the specificity (0.93) of the screening. A method of calculating the sensitivity and specificity of the test method by means of three samples was demonstrated.

Conclusion: The data confirm that it is possible to identify reliably children with developmental language disability at 2.5 y of age through the screening programme.
Anticholinergic treatment improves glycaemic control in adolescent girls with insulin‐dependent diabetes mellitus
Authors: Halldin MU , Aman J , Brismar K , Jones I , Tuvemo T , Gustafsson J
Published: August 2010

Metabolic control often deteriorates during puberty in girls with insulin‐dependent diabetes. It is well accepted that there is an abnormality in the growth hormone (GH)‐insulin‐like growth factor‐I (IGF‐I) axis in these girls, resulting in reduced IGF‐I levels and elevated GH. As GH antagonizes insulin, attempts have previously been made to reduce excess GH secretion through anticholinergic treatment. However, most of these studies have been performed on adult patients. The aim of the present study was to evaluate the effects of 12 wk of oral anticholinergic treatment with Pirenzepine, 100 mg twice daily, in 16 adolescent girls with diabetes. Serum samples of IGF‐I, glycated haemoglobin and fasting IGF‐binding protein 1 were analysed at initiation and after 3, 8 and 12 wk of Pirenzepine therapy. Nocturnal urinary GH excretion was also examined. Glycated haemoglobin declined significantly after 3 wk of Pirenzepine therapy (9.8 ± 0.18 vs 9.2 ± 0.17; p < 0.001) and was still improved at the end of the study. Unexpectedly, nocturnal urinary GH excretion did not change. Serum IGF‐I continuously increased during the study, while IGF‐binding protein 1 levels were not significantly altered.

Conclusion: Anticholinergic treatment with Pirenzepine improves glycaemic control in adolescent girls with diabetes. Although nocturnal urinary GH excretion was unchanged there may still be changes in pituitary GH secretion to explain the improvement. Effects of Pirenzepine on gastrointestinal motility can represent other possible mechanisms behind the improved metabolic control.
Comparison of airway pressure and airflow triggering systems using a single type of neonatal ventilator
Authors: Dimitriou G , Greenough A , Cherian S
Published: August 2010

The performances of two triggering systems using a single neonatal ventilator type (SLE) were compared. Eight infants, gestational age 27–30 wk, were each recorded during two 1‐h periods of patient‐triggered ventilation (PTVs), one with airway pressure and one with airflow triggering. The airflow trigger had a shorter trigger delay (p < 0.02), higher sensitivity (p < 0.02) and lower asynchrony rate (p < 0.02).

Conclusion: In immature infants with mild respiratory distress syndrome using the SLE ventilator with inflation times of 0.3 to 0.36 sec, airflow triggering is more appropriate than airway pressure triggering.
Introduction of solids and formula to breastfed infants: a longitudinal prospective study in Uppsala, Sweden
Authors: Hörnell A , Hofvander Y , Kylberg E
Published: August 2010

The introduction of solids and formula was studied among 506 breastfed infants in Uppsala, Sweden, based on daily recordings during the first year. The mothers had previously breastfed at least 1 infant for at least 4 mo. Thirty‐four per cent of the infants were introduced to solids before the age of 4 mo (4–6 mo is recommended in Sweden). Accustoming the infants to solids was a lengthy process. Life‐table analyses showed a median duration of 28 d from the first introduction of solids to consumption of >10 ml daily, and 46 d before the infants ate 100 ml of solids in 1 d for the first time. These durations were longer the younger the infant was at the introduction of solids. Thirty‐two per cent of infants given formula consumed 100 ml the first time it was given, and 49% did so within 1 wk, regardless of infant age.

Conclusion: Parents and healthcare personnel need to be aware that accustoming breastfed infants to solid food is a lengthy process, and that there is a strong age effect on this duration. It is also important to consider what consequences the (usually) more abrupt introduction of formula might have on breastfeeding.
Morning versus evening administration of estradiol to girls with Turner syndrome receiving growth hormone: impact on growth hormone and metabolism. A randomized placebo‐controlled crossover study
Authors: Naeraa RW , Gravholt CH , Kastrup KW , Svenstrup B , Christiansen JS
Published: August 2010

Timing of 17β‐estradiol (E2) administration in relation to that of GH could influence the “first pass effect” of E2 on hepatic IGF‐I secretion. In order to test this hypothesis, a randomized double‐blind placebo‐controlled crossover study was conducted. Nine Turner girls (12.8–20.0 y) were treated for 2 mo periods with GH 0.1 IU/kg/d sc at bedtime, and oral E2 6–11 μg/kg/d in the morning and placebo in the evening in one 2‐mo period and vice versa in the other period. After each period, 24‐h blood sampling was performed. IGF‐I and mean 24‐h integrated GH were comparable. However, the IGF‐I/IGFBP‐3 ratio was higher (p= 0.05) and insulin levels were lower after evening administration of E2 (24 h: p= 0.03). During an oral glucose tolerance test in the morning, glucagon and insulin were lower following evening E2 administration (ANOVA: glucagon, p= 0.03; insulin, p= 0.04), as well as insulin resistance tended to be lower (p= 0.09).

Conclusion: The timing of oral E2 supplementation modulates the IGF‐I/IGFBP‐3 ratio, insulin and glucagon levels in Turner syndrome during GH treatment. Evening administration of oral estrogen together with evening injections of GH may be preferable.
Pre‐school children with developmental co‐ordination disorder: self‐perceived competence and group motor skill intervention
Authors: Pless M , Carlsson M , Sundelin C , Persson K
Published: August 2010

Objective: To investigate self‐perceived competence in 5‐ to 6‐y‐old children with developmental co‐ordination disorder. Subjects and methods: Scores in two scales of self‐perceived competence were compared between a study group of children with developmental co‐ordination disorder (n= 37) and a reference group (n= 60). In addition, effects of group motor skill intervention were evaluated by comparing scores in study group children randomly allocated to an intervention (n= 17) and a control subgroup (n= 20). The intervention subgroup received intervention once weekly for 10 wk

Conclusions: Pre‐school children with developmental co‐ordination disorder are similar to peers of the same age regarding self‐perception of their own competence in areas concerning school, peer relations and motor skills. The change in score in the perceived motor competence scale was significantly greater in the intervention than in the control subgroup, suggesting that the intervention increased individual awareness of motor competence.
Development and behaviour of seven‐year‐old triplets
Authors: Garel M , Salobir C , Lelong N , Blondel B
Published: August 2010

The aim of this study was to assess the development and behaviour of 7‐y‐old triplets, who were followed from delivery to 7 y of age. The McCarthy Scales of Children's Abilities (MSCA) and Achenbach's Child Behaviour Checklist (CBCL) were used to assess and compare development and behaviour in the triplets and in a control group of singletons. The sample included 33 sets of triplets and 33 singletons, all 7‐y‐olds, and comparable for sex and fathers' social class. The triplets' scores on the MSCA were all within normal range. Although their mean scores for all subtests were below those of singletons, they did not differ significantly. The mean CBCL scores, based on mothers' reports, indicated that the triplets had significantly fewer behavioural problems than the controls. In half the triplet sets, one child stood out as having more behavioural problems than the others.

Conclusion: Further assessments of the development of triplets are needed; these should be based on larger study samples and should use information from teachers and external observers as well as mothers.
Microcephalus, medulloblastoma and excessive toxicity from chemotherapy: an unusual presentation of Fanconi anaemia
Authors: Ruud E , Wesenberg F
Published: August 2010

Fanconi anaemia is a genetically and phenotypically heterogeneous disorder with different forms of clinical presentation. In this case the patient had suffered from microcephalus and delayed motor development from birth, but extensive investigation did not disclose any aetiology. At 3.5 y she developed a cerebellar medulloblastoma which was treated with surgery and chemotherapy. Following chemotherapy with alkylating agents she suffered from severe bone marrow aplasia which caused life‐threatening infections, feeding problems and impaired kidney function. Fanconi anaemia was suspected, but it took 2 mo before the chromosome fragility test came out positive. From the moment diagnosis of Fanconi anaemia was made, no further active treatment was given. The patient's condition improved for some time, but she relapsed and died exactly 1 y after the first diagnosis of brain tumour.

Conclusion: Fanconi anaemia must always be suspected in patients who experience excessive toxicity from chemotherapy regardless of the type of malignancy and congenital malformations.
Hepatic technetium‐99m‐mebrofenin iminodiacetate scans and serum γ‐glutamyl transpeptidase levels interpreted in series to differentiate between extrahepatic biliary atresia and neonatal hepatitis
Authors: Arora NK , Kohli R , Gupta DK , Bal CS , Gupta AK , Gupta SD
Published: August 2010

Hepatic technetium‐99m‐mebrofenin iminodiacetate (99mTc‐mebrofenin IDA) scans and serum γ‐glutamyl transpeptidase (GGTP) have high sensitivity for extrahepatic biliary atresia (EHBA). This study was based on the hypothesis that the interpretation of results of 99mTc‐mebrofenin IDA scans and serum GGTP levels in series would result in a reduction of the false positivity observed with these tests individually. The aetiology of neonatal cholestasis in 132 study patients was: 25% (33/132) EHBA, 45.5% (60/132) neonatal hepatitis (NH) with an identifiable cause and 19.7% (26/132) idiopathic NH. Of the various clinical, biochemical and imaging parameters that were significantly different between patient groups, sensitivity for EHBA was: serum GGTP ≥ 150 IU 1−1(100%), 99mTc‐mebrofenin IDA scans (100%), pale stools (82.8%) and total serum bilirubin ≥ 12mg d1−1 (66%). However, specificity ranged from 48.5 to 79%. Of the 63 patients who had non‐excreting IDA scans, operative cholangiograms could be avoided on the basis of a specific aetiological diagnosis of NH, made concurrently, in only 9 infants. The rest (54) underwent operative cholangiograms; 21 (39%) of these had patent biliary trees and therefore underwent the procedure unnecessarily. If serum GGTP (<150 IU 1−1) had been used as a screen after IDA scanning in these 54 patients, operative cholangiograms could have been avoided in another 12 patients and thereafter only 9/42 (21%) of the operative cholangiograms would have been considered unnecessary.

Conclusion: A diagnostic algorithm is proposed wherein serum GGTP level (at a cut‐off level that maintains 100% sensitivity for EHBA) is used in series with non‐excreting 99mTc‐mebrofenin IDA scans (for patients with no specific aetiological label). This strategy reduces the false positivity of individual tests.
Incidence and predictors of atopic dermatitis in an open birth cohort in Sisimiut, Greenland
Authors: Tamsmark TH , Koch A , Melbye M , Mùlbak K
Published: August 2010

The frequency of atopic dermatitis (AD) is unknown among children in Greenland. To determine the incidence of AD and to identify risk factors for onset of AD within the first 2 y of life among Greenlandic children an open cohort of 143 children aged 0–2 y in Sisimiut, West Greenland, was followed for a median of 335 d. The children were visited on a weekly basis, where clinical examinations revealed any cases of AD. In total, 24 of the 143 children developed AD. The incidence rate of AD was 177 cases per 1000 child years at risk, corresponding to a cumulative risk of 16% per year. Maternal history of AD [hazard ratio (HR) 2.6, 95% confidence interval (CI) 1.03–6.57], high social class of the family (HR 6.18, CI 2.19–17.41) and living in a detached house compared with living in a terraced house or an apartment (HR 2.81, CI 1.16–6.28) were associated with increased risks of AD. In a multivariate model these risk factors all remained significant.

Conclusion: The findings confirm that AD represents a health problem among Greenlandic infants and that the pattern of predictive risk factors associated with the development of AD is comparable to that found in northern European countries.
Reluctance to continue breastfeeding in The Netherlands
Authors: Bulk‐Bunschoten AMW , van Bodegom S , Reerink JD , Jong PCM Pasker‐de , de Groot CJ
Published: August 2010

A prospective cohort study of breastfeeding practice (0–4 mo) was carried out in well‐baby clinics. The cohort included 4438 newborns brought to a clinic for the first time between 1 April and 1 July 1998. The odds ratios of demographic and gestational variables connected with the start and duration of breastfeeding were measured. The frequency of the reasons why breastfeeding was interrupted was determined. At birth 71% of the infants included in this study were exclusively breastfed. After 4 mo the percentage had dropped to 21%. Breast milk was replaced directly by formula (23%) or by a mixture of breast milk and formula (77%). Exclusive breastfeeding was given irrespective of the mother's cultural background. Higher education appeared to be the most decisive factor for the initiation of exclusive breastfeeding; higher parity was found to be the most decisive factor for continuation. In 46% of cases the infant's health and behaviour caused mothers to stop exclusive breastfeeding; in 38% the reasons were mother related; in 17% both mother‐ and infant‐related motives were mentioned.

Conclusion: Mothers' perception of hunger and crying colics were the main infant‐related reasons for cessation of breastfeeding, whereas physical problems, return to work, doubt about the sufficiency of breast milk and the feeling of being restricted by breastfeeding were the main mother‐related reasons. The decision to abandon exclusive breastfeeding was made primarily by mothers (71%). In The Netherlands more babies are breastfed at birth than was the case 10 y ago, but the duration of the breastfeeding period has become shorter.
Cause‐specific stillbirth and neonatal death in Sweden: a catchment area‐based analysis
Authors: Serenius F , Winbo I , Dahlquist G , Källén B
Published: August 2010

A register‐based study of the impact of obstetric and neonatal care on stillbirth and neonatal death rate was performed on all births in Sweden in 1983–1995. Each birth was assigned to a primary delivery hospital where the mother with a term singleton pregnancy was most likely to have been delivered (not possible for 25% of the deliveries), and the catchment areas of each hospital were classified according to the level of care of that hospital. Only small differences in total mortality existed between the different levels of care of the primary hospital: areas served by primary hospitals with obstetric service and resources for neonatal intensive care including continuous positive airway pressure but without facilities for ventilator treatment for prolonged periods showed a 7% excess risk of stillbirth or neonatal death.

Conclusion: In areas with the lowest level of care of the primary delivery hospitals (with no or only basic neonatal care) the total mortality was not increased, indicating that the referral system works well. When the analysis was repeated for specific causes of death, more marked differences were noted, especially for death due to obstetric complications where the death risk increased with decreasing level of care of the primary delivery hospital. Even though no marked differences in total mortality were seen, a further reduction can be obtained by increasing referral for some specific conditions.
Association of a mutation in the β3‐adrenergic receptor gene with obesity and response to dietary intervention in Chinese children
Authors: Xinli W , Xiaomei T , Meihua P , Song L
Published: August 2010

This study aimed to determine whether the Trp64Arg mutation in the β3‐adrenergic receptor (β3‐adr) gene is related to childhood obesity and the response to dietary intervention for obesity. The study included 311 healthy children aged 8‐11 y selected at random from 4 primary schools in Beijing. Fasting insulin and lipids were measured and anthropometry was carried out for all samples. The mutation of the β3‐adr gene was determined by polymerase chain reaction‐restriction fragment length polymorphism analysis. Forty‐seven obese children were selected and divided into two groups. One group received dietary intervention (36 subjects); the other served as the control group (11 subjects). After 3 mo of dietary intervention, anthropometry was carried out again in 47 obese children. The frequency of the mutated allele was similar in 73 overweight and 238 normal‐weight children (0.18 and 0.17, respectively). Adjusted for age and sex, there was no significant difference in body mass index (BMI) and the levels of fasting lipids and insulin between those with and without the mutation of the 311 children. However, after 3 mo of dietary intervention, increases in weight and BMI were significantly lower in obese children without the mutation than in the control group (2.41 ± 0.56 vs 4.43 ± 0.70, p < 0.05; 0.48 ± 0.24 vs 1.55 ± 0.35, p < 0.05, respectively), but the changes in weight and BMI in obese children with the mutation were similar to the results in the controls (4.32 ± 0.69 vs 4.43 ± 0.70; 1.47 ± 0.32 vs 1.55 ± 0.35).

Conclusion: The Trp64Arg mutation of the β3‐adr gene may predict the result of dietary intervention in obese children to some extent, but it was not a major factor affecting weight in Chinese children.
High prevalence of coeliac disease in Danish children with type I diabetes mellitus
Authors: Hansen D , Bennedbæk FN , Hansen LK , Høier‐Madsen M , Hegedüs L , Jacobsen BB , Husby S
Published: August 2010

The purpose of this population‐based study was to determine the prevalence of coeliac disease (CD) in 106 Danish children (age 2‐18 y) with type I diabetes mellitus compared with 106 age‐and sex‐matched healthy controls. Serum samples were analysed for immunoglobulin A (IgA) and IgG gliadin antibodies by enzyme‐linked immunosorbent assay (ELISA), for IgA endomysium antibodies (EMA) by immunofluorescence and for IgA tissue transglutaminase antibodies (tTGA) by ELISA. None of the controls had EMA or tTGA. Two diabetics previously diagnosed with CD were antibody negative on a gluten‐free diet. Ten diabetics had both EMA and tTGA. Intestinal biopsy was performed in nine of them. All biopsies showed a histological picture of partial or total villous atrophy confirming the diagnosis of CD. Diabetics with CD were significantly younger (p= 0.026), had an earlier onset of diabetes (p= 0.005), had a lower height standard deviation score (p= 0.019) and more often had thyroid antibodies (p= 0.040) compared with diabetics without CD.

Conclusion: A high prevalence of CD of 10.4% (95% confidence interval 4.6–16.2%) was found in young Danish diabetics. Early onset of diabetes may predispose to CD. Routine serological screening for CD may be valuable in patients with type I diabetes mellitus.
Decreased lung function associated with perinatal exposure to Dutch background levels of dioxins
Authors: ten Tusscher GW , de Weerdt J , Roos CM , Griffioen RW , De Jongh FH , Westra M , van der Slikke JW , Oosting J , Olie K , Koppe JG
Published: August 2010

Perinatal exposure to Dutch background dioxin levels is rather high. Studies of calamities have shown that dioxins negatively influence the respiratory system. It was hypothesized that perinatal exposure to background dioxin levels leads to lung suboptimality, probably through developmental interference. This study aimed to assess lung function in relation to perinatal dioxin exposure. Spirometry was performed in 41 healthy children (aged 7‐12 y, mean 8.2 y) with known perinatal dioxin exposure. The ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC ratio) was determined. A complete medical history was taken. The prenatal exposure ranged from 8.74 to 88.8 (mean 34.6) ng TEQ dioxin kg fat−1, measured in breast milk. The postnatal exposure ranged from 4.34 to 384.51 (mean 75.4) ng TEQ dioxin. Twelve children had to be excluded. A significant decrease in lung function in relation to both prenatal (p= 0.045) and postnatal (p= 0.0002) dioxin exposure was seen in the 29 non‐excluded children. A clinical association between chest congestion and perinatal dioxin exposure was seen.

Conclusion: Perinatal background dioxin exposure may be inversely associated with the FEV1/FVC ratio.
Vaccination rate and age of premature infants weighing <1500 g: a pilot study in north‐western Switzerland
Authors: Tillmann BU , Tillmann H‐C , Nars PW , Weber P
Published: August 2010

In Switzerland, there are no special vaccination recommendations for premature and low‐birthweight infants with respect to a particular target vaccination age. Incomplete and delayed vaccination bears the inherent risk of preventable infections. Therefore, the vaccination rate and age of 60 premature infants in north‐western Switzerland born in 1994/95 were investigated in a retrospective case‐control study. For this group of patients these are the first data ever available for this region. At the age of 4–5 y, the vaccination rates for polio and diphtheria, tetanus, pertussis (DTP acellular) as well as Haemophilus influenzae b (Hib) were similar in both preterm and full‐term infants. In both groups, the fourth dose of vaccine against DTP, Hib and polio was far less frequently administered than the first three. The vaccination age in preterm infants for most vaccinations was significantly higher than in age‐matched full‐term controls. This was particularly obvious for the first dose of vaccine against polio and DTP. In preterm infants, the median age (5th; 95th percentile) at the date of the first polio vaccination was 131 (89; 270) d and 82 (60; 182) in full‐term controls (p < 0.00001). The age difference was even larger for the first DTP vaccination (62 d, p < 0.00001). The main reasons for delayed vaccination may include insufficient information given to parents as well as prolonged hospitalization.

Conclusion: Vaccination of preterm infants should be discussed in every discharge communication, with emphasis on vaccine administration at the appropriate chronological age.
Uncertainties about the use of inhaled nitric oxide in preterm infants
Authors: Mercier J‐C ,   the Franco‐Belgium Neonatal Study Group on Inhaled NO
Published: August 2010

Respiratory failure in the premature neonate is frequently complicated by pulmonary hypertension. When conventional therapies including administration of exogenous surfactant, conventional mechanical ventilation or high‐frequency oscillatory ventilation using an appropriate high‐volume strategy have failed, one should assess the pulmonary circulation status with colour‐coded Doppler echocardiography. There is now considerable evidence that the regulation of foetal and postnatal pulmonary circulation occurs via nitric oxide (NO), and that persistent pulmonary hypertension of the neonate may be related to a relative deficiency in NO release. Low‐dose (10–20 ppm), short‐duration (1–2 d) inhaled NO has generally been shown to improve the oxygenation and relieve pulmonary hypertension in premature neonates with severely hypoxaemic respiratory failure. Whether this therapy (eventually prolonged >1‐3 wk?) would improve survival and lessen morbidity (e.g. intracranial haemorrhage and chronic lung disease) remains to be proven by appropriately designed controlled trials. Until these issues can be clarified, NO therapy for premature neonates should be still considered as an experimental drug, and its use restricted to clinical studies.
Animal‐derived or synthetic surfactant for the treatment of neonatal respiratory distress syndrome: a review
Authors: Milligan DWA , Ainsworth SB
Published: August 2010

Animal‐derived surfactants containing SP‐B and SP‐C are more effective in vitro and in animal models than their synthetic counterparts, but are not as effective as unmodified, naturally occurring surfactant. In clinical trials involving newborn babies with respiratory distress syndrome (RDS) these short‐term differences are reflected as improvements in gas exchange and lung function. Treatment with animal‐derived surfactants results in fewer air leaks and lower neonatal mortality. The evidence is now strong enough to recommend routine use of animal‐derived surfactants in very preterm infants with RDS. The newer generation of synthetic surfactants may be important in the future as they have the advantages of currently available animal products with the addition of better resistance to inactivation.
Which place for bismuth subsalicylate in the treatment of enteric infections?
Authors: Guarino A , Bruzzese E
Published: August 2010

ORS has led to improved outcome of acute gastroenteritis in both industrialised and developing countries. In both settings there is an increasing demand for active therapy to reduce the duration of diarrhoea and its complications. Persistent diarrhoea is a major consequence of intestinal infections and is responsible for a high number of deaths in poor countries. Bismuth subsalicylate has been used for treatment of acute diarrhoea, with preliminary promising results. In this issue of Acta Paediatrica, a trial with BSS is essential. However the results were marginal and did not justify a mass scale use of BSS, also because of poor cost efficacy rate.
High prevalence of stress hyperglycaemia in children with febrile seizures and traumatic injuries
Authors: Valerio G , Franzese A , Carlin E , Pecile P , Perini R , Tenore A.
Published: August 2010

Although hyperglycaemia is relatively frequent in the course of severe illnesses and may be looked upon as the possible result of an uncoordinated insulin response to the increased glucose that the body may need during periods of stress, it is generally agreed that it does not constitute a prediabetic condition. Numerous studies have aimed to explain the pathophysiology of this occurrence but none has looked at which conditions are more prone to develop stress hyperglycaemia (SH). Therefore, the aim of this study was to evaluate the main clinical conditions that may be associated with SH in children. A total of 1199 children was studied: 833 children (439 M, 394 F, mean age 5.2 ± 4.5 y) admitted for an acute illness or injury constituted the stress‐exposed group, while 366 children (222 M, 144 F, mean age 6.2 ± 4.6 y) admitted for elective minor surgery represented the stress‐unexposed group and were considered as the control group. SH was defined as plasma glucose concentrations ≥8.3 mmol I−1 during an acute illness. Stress‐exposed patients had significantly higher glycaemic levels than controls (5.6 ≥1.4 vs 4.7 ≤0.7 mmol I−1; p < 0.0001). SH was found in 41 (4.9%) stress‐exposed patients and in none of the controls. SH was significantly more prevalent in children affected by febrile seizures (12.9%) or traumatic injuries (11.7%; p < 0.008 and p < 0.02, respectively, vs other diagnoses). A significant correlation was found between glycaemia and systolic pressure (r=0.1; p < 0.01), white cell count (r= 0.12; p < 0.0003) and body temperature (r= 0.16; p < 0.0001). SH was more frequent in patients with body temperature >39°C (14%) than in those with a temperature <39°C (4%; p < 0.0008). SH was more prevalent in clinical conditions of fever associated with seizures or pain (12.9% and 12.5%, respectively) than fever alone (4.4%). After a mean period of 3.5 ± 0.6 y of follow‐up none of the hyperglycaemic patients had developed diabetes mellitus.

Conclusion: Traumatic injuries, febrile seizures or conditions in which an elevated body temperature may be found are frequently associated with SH in children. In the presence of these conditions specific studies directed towards unmasking a prediabetic state may be unnecessary.
Association between urinary tract infection, renal damage and birth size
Authors: Hellström M , Hessel H , Jacobsson B , Jodal U , Niklasson A , Wennerström M , Hellström A
Published: August 2010

The aim of this study was to investigate whether birth size is associated with permanent renal damage in children with urinary tract infection (UTI). A cohort of 1221 children under 16 y of age was diagnosed with their first symptomatic UTI between 1970 and 1979. Of these, 74 had urographic renal scarring in childhood and 57 were re‐examined as adults. The birth files of 48 of these patients (35F, 13M) were available, and birthweight and birthlength in relation to gestational age were analysed and compared with a Swedish reference population. Children who had renal damage without vesicoureteric reflux were significantly smaller at birth (median weight, ‐0.76 SDS) compared with both children who had renal damage and reflux (median weight, ‐0.01 SDS) and the reference population.

Conclusion: The demonstration of low birthweight among children with UTI and renal damage but no reflux suggests that low birthweight may be a risk factor for the development of renal damage.
Do normal leucocyte count and C‐reactive protein value exclude acute appendicitis in children?
Authors: Grönroos JM
Published: August 2010

The present study aimed to determine the role of leucocyte count and C‐reactive protein (CRP) measurements in the diagnosis of acute appendicitis in children. In particular, children with acute appendicitis but normal leucocyte count and CRP level were sought. The present study protocol was identical to those used in earlier studies on adult patients with suspected acute appendicitis. The mean preoperative leucocyte count and CRP value in 100 consecutive children with an uninflamed appendix at appendicectomy (group A) and in 100 consecutive patients with acute appendicitis (group B) were calculated. The numbers of patients with (i) both values normal, (ii) only leucocyte count raised, (iii) only CRP level raised, and (iv) both values raised were calculated in both groups A and B. Leucocyte count effectively (p < 0.001) separated children with uninflamed appendix (mean ± SEM 10.2 ± 0.4 ± 109 1−1) from those with acute appendicitis (15.0 ± 0.4 ± 109 1−1), but the CRP value was of no use in this respect (p= 0.866; 31 ± 4mg 1−1 and 30 ± 4mg 1−1). The most conspicuous finding was that in children with acute appendicitis, both values were normal in 7 out of 100 patients.

Conclusion: Contrary to adult patients, normal leucocyte count and CRP value do not effectively exclude acute appendicitis in children.
Early oral behaviour in preterm infants during breastfeeding: an electromyographic study
Authors: Nyqvist K Hedberg , Färnstrand C , Eeg‐Olofsson K Edebol , Ewald U
Published: August 2010

The objectives were to increase the understanding of the characteristics of oral behaviour during breastfeeding in preterm infants and to validate direct observations of infant sucking. Twenty‐six infants were investigated once by simultaneous observation and surface electromyography (EMG) at 32.1–37.1 postmenstrual weeks. The orbicularis oris muscle was used for data analysis, as it provided the most distinct registrations. High correlation coefficients were observed with respect to classifications of EMG data by two raters on the number of sucks per burst (r= 0.97) and duration of sucking bursts (r= 0.99). The agreement between direct observations of sucking and EMG data was high. The median for mean number of sucks per burst was 8 (range 2–33) and for longest burst 28 (5–96) sucks. Sucks with low and very high intensity constituted a median of 14 (1–94)% and 25 (0–87)% of all sucks. The range in mean sucking frequency was 1.0–1.8 sucks s‐1. Suck duration ranged from 0.6 to 1.1 s. There was a considerable variation between infants in the extent of mouthing. No association with maturational level appeared for any of the components in oral behaviour.

Conclusion: EMG data provided evidence of early sucking competence in preterm infants during breastfeeding, with wide individual variations. Surface EMG and direct observation are recommended as valid methods in the evaluation of breastfeeding behaviour in preterm infants.
Lower limb and back pain in Guillain‐Barré syndrome and associated contrast enhancement in MRI of the cauda equina
Authors: Wilmshurst JM , Thomas NH , Robinson RO , Bingham JB , Pohl KRE
Published: August 2010

This study assesses the frequency of lower limb and back pain in children with Guillain‐Barré syndrome and reviews the magnetic resonance imaging results of those undergoing spinal imaging. Over an 8‐y period, nine children presented with various combinations of severe back pain, leg pains, impairment of gait and bladder dysfunction. Guillain‐Barré syndrome was confirmed on clinical examination and peripheral electrophysiology (n= 8). Magnetic resonance imaging in four patients, following contrast injection, showed enhancement of the cauda equine and, additionally, of the cervical nerve roots in one of the patients. A further patient, who was not scanned with contrast, had abnormal thickening of the lumbar roots. Carbamazepine and steroids were effectively used for analgesia in three cases. All the patients recovered.

Conclusion: Guillain‐Barré syndrome should be considered in the differential diagnosis of children presenting with back and/or leg pain. Early diagnosis ensures prompt monitoring for autonomic dysfunction and respiratory compromise.