bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening for minimal brain dysfunction (MBD/DAMP) at six years of age: results of motor test in relation to perinatal conditions, development and family situation
Authors: Larsson J‐O , Aurelius G , Nordberg L , Rydelius P‐A , Zetterström R
Published: January 2008

The aim of this study was to investigate if children aged 6 years of age, classified as having minimal brain dysfunction (MBD) or deficit in attention, motor control and perception (DAMP), exhibit special medical problems, specific developmental features or if special psychosocial conditions exist in the family. The screening program, using the psychoneurological part of the method developed by Gillberg et al., included 234 children who were followed‐up prospectively from pregnancy and birth. The results were related to the physical and mental development of the children, to the psychosocial and socioeconomic conditions of the families, to pre‐ and postnatal conditions and to “reduced optimality score”, as defined by Prechtl. Mental development was assessed by the use of Griffiths' test at 10‐14 months and at 4‐5 years of age. At the second Griffiths' test, the mother was also interviewed about the presence of aggressiveness and other symptoms of childhood psychopathology in her child, as defined by the DSM‐III criteria, and a psychological observation was also made. In addition to screening for MBD/DAMP, at 6 years of age the parents were asked to complete a questionnaire aimed at identifying attention deficit disorder (ADD). No medical or psychological intervention was made before this stage. Fourteen children (9M, 5F) (6%) were identified as having a positive MBD/DAMP screening result. The results of the screening procedure showed a weak correlation with those obtained using the questionnaire based on the DSM‐III criteria for ADD. Compared with the rest of the children, those with a positive MBD/DAMP screening result had an increased number of complications during pregnancy but not a reduced optimality score. At 4 years of age the performance on the Griffiths' test was lower and the rate of child psychiatric symptoms such as aggressiveness and signs of the mother having difficulties in setting limits for the child were more common than among the rest of the cohort. No relation was found with the psychosocial or socioeconomic conditions of the family. We conclude that children suspected of having MBD/DAMP at the start of school may have exhibited signs of delayed psychoneurological development and symptoms of psychopathology at 4 years of age.
Social and behavioural perspectives in enuretics, former enuretics and non‐enuretic controls
Authors: Wille S , Anveden I
Published: January 2008

Social and behavioural traits in children with primary nocturnal enuresis were compared with children who had outgrown their enuresis and children who had never bed‐wetted after three years of age. The study group included 14 children with primary nocturnal enuresis, 15 children who had had primary nocturnal enuresis and 15 age‐ and sex‐matched controls. The mothers of all children were interviewed using a 32‐item questionnaire. If primary nocturnal enuresis were a neurotic disease, we would have expected a higher frequency of emotional dysfunction in children with enuresis and an increase in the symptoms or symptom substitution when bed‐wetting was resolved. No significant differences in emotional or behavioural traits among the three groups were found. We conclude that children with primary nocturnal enuresis were well adjusted individuals and display similar social and behavioural traits as their peers. This study lends further support to the theory that primary nocturnal enuresis is not a psychological disorder.
Prediction of the growth response of short prepubertal children treated with growth hormone
Authors: Kristrom B , Karlberg J , Albertsson‐Wikland K ,   and the Swedish Paediatric Study Group for GH treatment
Published: January 2008

The aim of this study was to identify predictors of the growth response to growth hormone (GH) during the first 2 years of GH treatment, using auxological data and the maximum GH response (GHmax) to provocation tests. The patients were 169 prepubertal short children (27F, 142M), with Gmax values ranging from 0 to 65 mU/1. Their mean age (± SD)was8.3 ± 2.4 years (range 3‐13 years), mean height SDS –3.0 ± 0.7 (range –1.5 to –6.0SDS) and mean pretreatment height velocity was normal (± 0.0 SDS) (range ‐1.6 to + 0.9 SDS). The increase in height SDS during the first 2 years of GH treatment (0.1 U/kg/day) varied from 0.10 to 3.75 SDS, with younger children having a better growth response. Individual growth responses correlated (p< 0.001) with GHmax(r=–0.37), age (r= ‐0.35), 1‐year pretreatment delta SDS (r = ‐0.25), mid‐parental height SDS (r = 0.34), height SDS at start of treatment (r =–0.22) and difference between height SDS of an individual child at the onset of GH treatment and mid‐parental height expressed in SDS (diff SDS) (r =–0.43). In a multiple stepwise linear regression model, diff SDS and log GHmax were found to be the strongest predictors of the magnitude of the growth response. In the short children in this study who exhibited a broad range of GHmax values, 33% of the growth response during the first 2 years of treatment could be predicted.
Thyroid autoantibodies, Turner's syndrome and growth hormone therapy
Authors: Ivarsson S‐A , Ericsson U‐B , Nilsson KO , Gustafsson J , Hagenäs L , Häger A , Moell C , Tuvemo T , Westphal O , Albertsson‐Wikland K , Åman J
Published: January 2008

The prevalence of thyroid autoantibodies, i.e. thyroglobulin antibodies and antibodies to thyroid peroxidase, was analyzed in 89 girls, aged 3‐16 years (mean age 10 years), with Turner's syndrome. The analyses were performed before the start of growth‐promoting treatment and during a follow‐up period of 1‐5 years. The patients were divided into four groups according to karyotype as follows: group 1, 45, X (n= 63); group 2 with structural abnormalities of the X chromosome (n= 4); group 3 with mosaicism but no structural abnormalities of the X chromosome (n = 10); and group 4, with isochromosome X of the long arm (n = 12): 199 healthy girls aged 12 years, served as controls. Thyroid autoantibodies were demonstrated in 46 of 89 (52%) patients with Turner's syndrome compared with 34 of 199 (17%) age‐matched control girls (p < 0.001), thus confirming the relationship between thyroid abnormalities and Turner's syndrome. There was also an increase in the prevalence of thyroid antibodies with age. Simultaneous presence of both autoantibodies was significantly more frequent in group 1 (45, X) and group 4 (isochromosome X of the long arm) than in group 3 (mosaicism) (p= 0.04 and p < 0.002, respectively) and significantly more frequent in group 4 than in group 1 (p < 0.05). During 12‐60 months of growth‐promoting treatment, no increase in the prevalence of thyroid antibodies was observed. The findings demonstrate the importance of continuous monitoring of thyroid function in girls with Turner's syndrome.
Scoring approaches to the recognition of cases of sudden infant death syndrome
Authors: Kelmanson IA
Published: January 2008

The aim of this study was to create a scoring method to distinguish between sudden infant death syndrome (SIDS) and cases of sudden death resulting from life‐threatening conditions (LTC). Four hundred infants less than one year old who died suddenly out of hospital in St Petersburg between 1983 and 1990 and who underwent a complete autopsy, were entered into the study. In 200 cases, the main diagnosis was SIDS, while in the remaining 200 cases, death was interpreted as resulting from LTC; 115 clinical and 240 morphological signs and symptoms were evaluated in each case. The statistical approach was based on the method of stepwise logistic regression analysis and it helped to identify 6 clinical and 12 morphological signs which, combined, made it possible to distinguish between SIDS and non‐SIDS (LTC) cases most accurately.
Remission following an elemental diet or prednisolone in Crohn's disease
Authors: Papadopoulou A , Rawashdeh MO , Brown GA , McNeish AS , Booth IW
Published: January 2008

The short‐ and long‐term effects of an elemental diet in children with acute Crohn's disease were compared with those of prednisolone in historical controls. Clinical remission was induced in 25 of 30 and in 18 of 28 episodes treated for six weeks with an elemental diet and prednisolone. Patients with proximal disease had longer remission after treatment with an elemental diet (p < 0.05) than did patients with colonic disease after treatment with prednisolone (p < 0.01). Disease activity index score improved in both groups compared with the pretreatment scores (p < 0.05). However, the improvement in the elemental diet group was significantly better than in the prednisolone group (p < 0.001). Changes in linear growth were better after treatment with an elemental diet compared with steroids (p < 0.001). Serum albumin and haematocrit concentrations all improved significantly in the children treated with an elemental diet (p < 0.001) but not in those treated with steroids. Thus an elemental diet was better than prednisolone in proximal disease and confirmed improved growth and nutritional status.
Apnoea detection: human performance and reliability of a computer algorithm
Authors: Macey PM , Ford RPK , Brown PJ , Larkin J , Fright WR , Garden KL
Published: January 2008

We examined the consistency of apnoea recognition between three human experts. The hypothesis was that computer detection of apnoea could emulate human expert apnoea recognition. The aim was to detect apnoeas with the highest possible accuracy from a single breathing signal, by both human experts and computer. Three human experts independently examined recordings of breathing waveform from overnight sleep studies from 10 infants aged 3‐17 weeks. All apnoeas of 5 s or more were identified and reviewed. However, there still remained 10% disagreement. A computer apnoea detector was implemented. An algorithm analysed statistical properties of the signal to find breathing pauses. Optimal performance was 1 % missed apnoeas (compared with the agreed apnoeas identified by the three experts) and 29% false detections. This computer algorithm reliably identified most apnoeas but did not replace the human expert.Algorithm, apnoea, breathing, detection, expert
A general hospital population of childhood epilepsy
Authors: Braathen G , Theorell K
Published: January 2008

In a general hospital population of 74 000 children under the age of 16 years in southern Stockholm, 79 children were started on antiepileptic drugs due to epilepsy during the 2 year period 1990‐92. The mean annual incidence of childhood epilepsy in this area was 53 per 100 000 children younger than 16 years. Neurological impairments were identified in 35% of the children. The epilepsy diagnoses were set according to the International Classification System proposed by the International League Against Epilepsy. Partial seizures were seen in 52% of the children. The syndrome BECT was identified in 11%. The epilepsy was symptomatic in 30%, and therapy‐resistant in 23%.Children, classification, epidemiology, epilepsy
Hearing loss at the age of 5 years of children born preterm–a matter of definition
Authors: Herrgård E , Karjalainen S , Martikainen A , Heinonen K
Published: January 2008

The effect of three common hearing impairment criteria on the prevalence of hearing loss was evaluated in 58 prospectively followed‐up 5‐year‐old children born preterm at 32 weeks of gestation. Audiological assessment was done as part of an extensive neurodevelopmental evaluation at the age of 5 years. With the criterion based on the classification of the World Health Organization (average threshold hearing level >25dB at frequencies of 0.5, 1 and 2 kHz, classified according to the less impaired side) there were two preterm children with mild hearing impairment. With Clark's criterion (unilateral average threshold hearing level > 15dB at frequencies of 0.5, 1 and 2 kHz) eight children had slight hearing impairment; seven of these had conductive hearing problems. With the criterion of a single frequency‐specific deficit > 15 dB for 0.25‐4 kHz the number of hearing‐impaired children was 28 out of 54 (51.9%), most of whom had conductive or unspecified hearing deficits. Moreover, of the four multiply handicapped, retarded children whose pure tone thresholds were not assessed mon‐aurally, three would belong to the hearing‐impaired group according to Clark's criterion and four according to the frequency‐specific criterion, Hearing impairment, hearing impairment classification, low birthweight, preterm
Screening for neuroblastoma: a 9–year birth cohort–based study in Niigata, Japan
Authors: Asami T , Otabe N , Wakabayashi M , Kakihara T , Uchiyama M , Asami K
Published: January 2008

Between April 1985 and March 1994 (9 years), 229 346 babies were born in Niigata prefecture, and 201 888 (88.0%) underwent mass screening (MS) for neuroblastoma at 6 months of age. To date, 29 infants have been screen–detected as having neuroblastoma (1 :7908). All screen–detected patients survived after removal of the primary tumor. In the same birth cohort, 17 additional children were clinically diagnosed as having neuroblastoma. The cumulative incidence rate of neuroblastoma at 5 years of age was 10.5 per 100 000 live births in the 5–year birth cohort before MS was introduced, and 18.6 per 100000 in the first 5–year birth cohort after MS was introduced. These values were not statistically different. The birth cohort incidence rate increased significantly to 22.2 per 100000 (p < 5% compared with before MS) after the method of MS was changed to high–power liquid chromatography (HPLC), even though this latest birth cohort has not been followed for 5 years. The population–based mortality rate from neuroblastoma was 5.9 per 100 000 in the 5–year birth cohort before MS, and 4.5 per 100000 after MS in the first 5–year birth cohort, using the vanillymandelic acid (VMA) spot test. These values were not statistically significant. In contrast, no death was observed in the next 4–year birth cohort after MS using HPLC; however, this birth chohort has not yet been followed for 5 years.Mass screening, neuroblastoma
Rapidly progressive enlargement of the fourth ventricle in the preterm infant with post‐haemorrhagic ventricular dilatation
Authors: Rademaker KJ , Govaert P , Vandertop WP , Gooskens R , Meiners LC , Vries LS de
Published: January 2008

Six preterm infants who developed disproportionate enlargement of the 4th ventricle during the neonatal period, associated with post‐haemorrhagic ventricular dilatation (PHVD), before shunt placement are reported. Five of the six preterm infants developed cyanotic spells and/or bradycardias at the time of rapid enlargement of the 4th ventricle, suggestive of raised posterior fossa pressure, which resolved following insertion of and drainage from a subcutaneous reservoir. In one of the three survivors an isolated 4th ventricle was subsequently diagnosed later in infancy, requiring drainage. These data suggest that a combination of an enlarged 4th ventricle on ultrasound and cyanotic spells and/or bradycardias should lead to rapid release of raised pressure in the posterior fossa. Long‐term follow‐up of these children is necessary, as isolation of the 4th ventricle can subsequently develop.Hydrocephalus, intraventricular haemorrhage, isolated 4th ventricle, preterm infant
Congenital hypopituitarism with hypoplasia of the anterior pituitary gland and a normal posterior pituitary lobe
Authors: Kato F , Kikuchi K , Miyamoto S , Ohie T , Yamaguchi S
Published: January 2008

We report a female infant with congenital hypopituitarism. All anterior pituitary hormones were deficient, and the anterior pituitary gland was undetectable on magnetic resonance images. Antidiuretic hormone secretion was appropriate, and the posterior lobe was localized at the end of the stalk, in the sella. These observations suggest that the posterior pituitary gland may develop independently of the anterior lobe.Congenital hypopituitarism, hypoplasia of the anterior pituitary gland
Interleukin‐2 therapy of Langerhans cell histiocytosis
Authors: Hirose M , Saito S , Yoshimoto T , Kuroda Y
Published: January 2008

A 20‐month‐old girl was diagnosed with Langerhans cell histiocytosis on the basis of a seborrheic skin rash, multiple punched out bony lesions, and skin biopsy findings. Combination therapy including α‐interferon, vincristine, vindesine, cyclophosphamide, etoposide, cisplatin, betamethasone, THP‐adria‐mycin, cytarabine and methotrexate was ineffective. Because cyclophosphamide enhanced lesion growth within the skull, we administered an intravenous infusion of interleukin‐2 with remarkable efficacy. The reduction in lesion size with interleukin‐2 treatment paralleled the increase in the percentage of CD16‐positive natural killer cells in the peripheral blood.Interleukin‐2, Langerhans cell histiocytosis, natural killer cells
Latent coeliac disease in Italy
Authors: Troncone R ,   SIGEP Working Group on Latent Coeliac Disease
Published: January 2008

The term latent coeliac disease applies to patients who have a normal jejunal biopsy while taking a normal diet and, at some other time, before or since, have had a flat jejunal biopsy recovering on a gluten‐free diet. Nineteen such patients were identified after a multicentre search conducted under the auspices of the Italian Society for Paediatric Gastroenterology and Hepatology (SIGEP). Serological data and histological material suitable for morphometric analysis were available from 10 and 8 patients, respectively, while they were on a gluten‐containing diet. Neither gliadin antibodies nor increased density of intraepithelial lymphocytes are obligate markers of latent coeliac disease; endomysial antibodies are likely to be best predictors of evolution towards villous atrophy. Prospective studies are needed to allow a more precise definition of latent coeliac patient features.
Pneumocystis carinii pneumonia in preterm infants: report of two cases successfully diagnosed by non‐bronchoscopic bronchoalveolar lavage
Authors: Panero A , Roggini M , Papoff P , Moretti C , Contini C , Bucci G
Published: January 2008

We present two cases of Pneumocystis carinii pneumonia in apparently immunocompetent preterm infants presenting with unexplained respiratory distress associated with a predominantly interstitial process on the chest radiograph. Definite diagnosis was promptly established on the detection of cyst forms in the lung fluid obtained by non‐bronchoscopic bronchoalveolar lavage, and a favourable outcome was achieved.
Congenital erythropoietic porphyria associated with nephrotic syndrome and renal siderosis
Authors: Lange B , Hofweber K , Waldherr R , Schärer K
Published: January 2008

A 9‐year‐old boy with typical features of congenital erythropoietic porphyria who had received more than 50 blood transfusions developed the steroid‐resistant nephrotic syndrome in the presence of normal glomerular function and glucosuria. Renal biopsy showed focal segmental glomerulosclerosis and widespread iron deposits. Magnetic resonance scanning revealed advanced siderosis of liver and kidneys. During a 4 year treatment by desferrioxamine the serum ferritin level was reduced, proteinuria dropped and serum proteins increased whilst glomerular filtration decreased slowly. It is suggested that the nephrotic syndrome may be a consequence of renal siderosis amenable to iron‐chelating therapy.
Low sodium levels in serum are associated with subsequent febrile seizures
Authors: Kiviranta T , Airaksinen EM
Published: January 2008

Fever plays an important role in causing disturbances in fluid and electrolyte balance. Hyponatraemia has been thought to enhance the susceptibility to seizures associated with febrile illnesses in childhood. We have studied serum electrolyte levels in children with simple and complicated febrile convulsions. Sodium levels were lower in those children with complicated convulsions in comparison with those having simple convulsions (136.07 ± 3.06 mmoll−1, mean ± SD, n = 42, and 137.62 ±2.63mmoir1, n = 71, respectively; p < 0.01, Student's Mest). The sodium concentrations were lowest in children with repeated seizures (134.20 ± 2.30 mmoll−1, n= 15) compared with children having simple (p < 0.01, ANOVA, Duncan's test) or other complicated types of febrile convulsions: focal seizures (137.08 ± 3.82 mmoir1, n = 12, p< 0.01), seizures lasting longer than 15 minutes (138.00 ± 2.45 mmoll−1, n= 5, p < 0.05) and children over 5 years (136.70 ±2.06 mmoll−1, n= 10, p < 0.05). Serum potassium levels showed no statistically significant differences between the patient groups. Our results show that hyponatraemia may increase the risk for multiple convulsions during the same febrile illness.
Diagnostic value of chest radiography and electrocardiography in the evaluation of asymptomatic children with a cardiac murmur
Authors: Birkebæk NH , Hansen LK , Oxhøj H
Published: January 2008

We investigated the diagnostic value of the chest radiograph and ECG in the evaluation of whether asymptomatic children with a cardiac murmur had a heart disease as defined by echocardiography. One hundred children aged 1 month to 15 years (median 30.1 months) were included. After physical examination, a tentative diagnosis was made: 53 children had no heart disease, 24 had a probable heart disease and 23 children were thought to have heart disease on the basis of clinical assessment alone. After information from chest radiography and electrocardiography was obtained, the diagnoses were re‐evaluated. This resulted in a change of the tentative diagnosis in three children. However, the diagnosis in relation to the definite diagnosis by colour Doppler echocardiography was not changed to the correct diagnosis in any of these cases. In 24 cases, radiography suggested the presence of heart disease; however, only 10 of these had heart abnormalities on the colour Doppler echocardiogram (CDE). Three children had an abnormal ECG; all of these had abnormalities on the CDE, but they were already diagnosed as having heart disease by physical examination. We conclude that chest radiography and electrocardiography is of no help in the discrimination between heart disease and no heart disease in asymptomatic children referred for a cardiac murmur.
Erythrocyte cupric/zinc superoxide dismutase exhibits reduced activity in preterm and low‐birthweight infants at birth
Authors: Phylactos AC , Leaf A A , Costeloe K , Crawford MA
Published: January 2008

In a comparative study in term, preterm and low‐birthweight infants, the mean activity and standard error of the mean for copper/zinc superoxide dismutase (Cu/Zn SOD) in cord erythrocytes from five term small for gestational age infants was 0.94 ±0.10 SOD units (mg protein)−1. This value was significantly lower than the activity (2.34 ± 0.24) in nine term, appropriate for gestational age (AGA) babies (p < 0.005). In 15 preterm (AGA) infants, the activity at birth (1.05±0.07SOD units (mg protein)−) was also significantly lower (p < 0.001) relative to term AGA babies. An increased level of activity (1.59 ± 0.09) was detected in the red cells of eight preterm AGA infants on their expected date of delivery compared with (0.87 ± 0.06) at birth (p < 0.001). However, the activity (1.59 ± 0.09) was still lower than that detected in term AGA babies (2.34 ±0.24; p < 0.02). Similar findings were obtained when enzymatic activity was expressed in units per millilitre of packed erythrocytes. The low activity of Cu/Zn SOD in preterm and low‐birthweight babies may render them susceptible to diseases associated with membrane lipid peroxidation.
Late onset globoid cell leukodystrophy (Krabbe's disease)– Swedish case with 15 years of follow‐up
Authors: Arvidsson J , Hagberg B , Månsson J‐E , Svennerholm L
Published: January 2008

We describe a male patient with late onset globoid cell leukodystrophy (GLD) (Krabbe's disease) still alive at 24 years of age, with a well preserved intellectual and communicative capacity, in contrast to visual failure and severe central pyramidal and extrapyramidal motor disability with spasticity, dystonia, ataxia and peripheral neuropathy. Visual dysfunction began at 4 years of age, limping and balance problems at 8 years and epilepsy at 14 years of age. Neuroimaging at 15 years of age revealed white matter lesions, and nerve conduction velocity examinations showed a slowly developing polyneuropathy. Galactosylceramidase activity was reduced in leukocytes to 0.07μkat/kg protein compared with 0.02 (SD 0.01) μkat/kg protein in infantile GLD.
Interleukin‐1 receptor antagonist in the fetomaternal compartment
Authors: Bry K , Teramo K , Lappalainen U , Waffarn F , Hallman M
Published: January 2008

Interleukin‐1 (IL‐1) is a major mediator in infections and inflammation. Interleukin‐1 receptor antagonist (IL‐1ra) opposes the actions of IL‐1. IL‐1ra is present in exceptionally high concentrations in third trimester amniotic fluid. We studied IL‐1ra in amniotic fluid, fetal serum and newborn urine. The concentrations of IL‐1ra in amniotic fluid at mid‐trimester and at 25‐41 gestational weeks were 6.6 ± 0.5ng/ml (n = 30) and 100 ± 4ng/ml (n = 202), respectively. At mid‐trimester, amniotic fluid IL‐1ra was not dependent on fetal gender, whereas during the third trimester IL‐1ra was higher in female‐ than in male‐bearing gestations. Urine of normal term newborns during the first day of life contained a very high concentration of IL‐1ra (125 ± 16ng/ml, n= 50). Urinary concentration in female newborns was significantly higher than that in male newborns (202 ± 19ng/ml, n = 25 versus 49 ± 14ng/ml, n = 25). IL‐1ra concentration in fetal serum at 22‐36 gestational weeks was 0.50 ± 0.07ng/ml (n= 31) and at term 1.5 ± 0.3ng/ml (n= 17). Serum concentrations were not gender‐dependent. The gender differences in IL‐1ra concentrations may in part explain the lower susceptibility of female fetuses to infection.
Effect of combined treatment with gonadotropin releasing hormone analogue and growth hormone in patients with central precocious puberty who had subnormal growth velocity and impaired height prognosis
Authors: Saggese G , Pasquino AM , Bertelloni S , Baroncelli GI , Battini R , Pucarelli I , Segni M , Franchi G
Published: January 2008

Growth hormone‐insulin‐like growth factor‐I status and response to growth hormone therapy (0.6 IU/kg/week sc, six times a week for 12 months) were evaluated in 12 girls (chronological age 9.4 ± 1.6 years) suffering from central precocious puberty with growth velocity less than 4 cm/year and no substantial increase or decrease in predicted adult height during gonadotropin releasing hormone (Gn‐RH) analogue treatment (D‐Trp6‐LH‐RH, 60 μg/kg im/28 days). At baseline, large variations were observed in nocturnal growth hormone (GH) means (pathological values (< 3.6μg/l) 33.3%), stimulated levodopa GH peaks (pathological values (<10.0 μg/I) 28.6%) and serum insulin‐like growth factor‐I (IGF‐I) levels. Neither GH nor IGF‐I levels were correlated with growth velocity. During recombinant GH therapy, growth velocity increased significantly (baseline 3.0 ± 0.9 cm/year; 6 months 6.4 ± 1.9cm/year, p < 0.001 versus baseline; 12 months 6.0 ± 1.3cm/year, p < 0.001 versus baseline). There was a significant increase in height SDS for bone age (baseline –1.6 ±0.5 SDS; 12 months ‐1.04 ± 0.6SDS; p < 0.002) and in predicted adult height (baseline 152.0 ± 3.6cm; 12 months 155.9 ± 3.4cm; p < 0.002). Our results suggest that combined therapy with Gn‐RH analogues and recombinant GH can improve growth velocity and predicted adult height in girls with central precocious puberty and impaired height prognosis during Gn‐RH analogue treatment.
Spinal posture during pubertal growth
Authors: Nissinen M
Published: January 2008

A cohort of children was followed‐up annually from a mean age of 10.8‐13.8 years to determine the development of their posture. Of the sample of 1060 children, 847 (79.9%) participated in the final examination. Thoracic kyphosis and lumbar lordosis were measured annually with a spinal pantograph. Those children whose thoracic kyphosis in pantography was more than 35o at entry and 45o or more at the final examination underwent a lateral standing radiograph. The 3‐year incidence of Scheuermann's disease was 0.4%. The mean thoracic kyphosis increased and the mean lumbar lordosis decreased with age in both sexes, but these changes were not constant. Thoracic kyphosis was most pronounced at a mean age of 12.8 years and lumbar lordosis was least pronounced at a mean age of 13.8 years. In accordance with the literature, the wide individual variation found in this study for both thoracic kyphosis and lumbar lordosis during the pubertal growth period was mainly physiologic.
Study of lumbar spine bone mineral density in obese children
Authors: Schepper J De , Van den Broeck M , Jonckheer MH
Published: January 2008

Bone mineral density (BMD) was studied in 59 obese children (mean (± SD) age 11.8 ± 2.7 years) at the start of dietary treatment and compared with a control group, matched for sex, age and body height. Determinations of BMD were made at the level of the lumbar spine (L2‐4) by a commercial dual photon absorptiometer (Novolab 22A). Mean (± SD) BMD of the obese children (0.68 ± 0.12 g hydroxy appetite/cm2 (gHA/cm2)) was similar to that of the control group (0.70 ± 0.16 gHA/cm2). As in normal children, BMD of obese children was highly correlated with age (r= 0.70), body height (r = 0.65) and body weight (r= 0.55). The highest values for BMD were found in obese adolescents with the most advanced pubertal status. No sex difference in BMD was seen in the obese children when pubertal stage was taken into account. Lumbar spine BMD, corrected for age, was not related to the degree or duration of obesity. No influence of physical activity on spinal mineralization could be demonstrated in the obese group. In conclusion, obese children present with normal lumbar spine BMD.
Automatic needle insertion diminishes pain during growth hormone injection
Authors: Main KM , Jorgensen JT , Hertel NT , Jensen S , Jakobsen L
Published: January 2008

Non‐compliance in children receiving growth hormone (GH) treatment is often caused by pain on injection and difficulties in administration of GH. It has been suggested that automatic needle insertion diminishes pain perception. We quantitatively measured pain intensity on injection with two prototype pens for GH administration, providing either manual or automatic sc needle insertion, using a combined visual analogue/facial scale and a five‐item scale in 18 children. With the automatic pen there was a significantly lower maximum pain score compared with the manual pen (median 28.5 versus 52.0mm) as well as a lower mean pain score (mean 13.7 versus 23.5 mm). The five‐item scale revealed that automatic needle insertion was significantly less painful than manual insertion and 13 patients chose to continue treatment with the automatic pen. In conclusion, pain during GH injection can be significantly diminished by automatic needle insertion, which may improve compliance in long‐term GH treatment.
Congenital misalignment of pulmonary vessels: an unusual syndrome associated with PPHN
Authors: Ng PC , Lewindon PJ , Siu YK , To KF , Wong W
Published: January 2008

We report a case of misalignment of pulmonary vessels and review the clinical features of all 13 cases reported to date. All were term infants dying from severe persistent pulmonary hypertension of the newborn. We have identified a triad of features that will alert neonatal clinicians to the possibility of this diagnosis: association with other non‐lethal congenital malformations; delayed onset of presentation (especially after 12 h); and severe hypoxaemia refractory to conventional therapy. We recommend that any autopsy on newborn infants include a specific search for misalignment of pulmonary vessels to outline the pathophysiology and clinical significance of this disorder.
Aminophylline versus caffeine citrate for apnea and bradycardia prophylaxis in premature neonates
Authors: Larsen PB , Brendstrup L , Skov L , Flachs H
Published: January 2008

We investigated the efficacy and adverse effects of aminophylline and caffeine citrate in 180 premature neonates for 10 days and nights. Aminophylline (n = 98) and caffeine citrate (n= 82) were equally effective in preventing apnea and bradycardia. The caffeine citrate group had a lower median heart rate on day 3, fewer neonates with tachycardia and a smaller amount of gastric aspirate on day 7. The need for mononasal continuous positive airway pressure and respirator therapy was similar in both groups. We conclude that caffeine citrate is the drug of choice for apnea and bradycardia prophylaxis in premature neonates with a gestational age ≤33 full weeks.
Methaemoglobinaemia among neonates in a neonatal intensive care unit
Authors: Hjelt K , Lund JT , Scherling B , Bendixen S , Lundstram K , Stovring S , Voldsgaard P , Linnet K
Published: January 2008

After detection of a few clinical cases of methaemoglobinaemia (methb) in our NICU, a prospective clinical study was undertaken to determine the extent of the problem and to identify the causes. Consequently, during the following 8 months all haemoglobin tests included simultaneous measurements of methb on an OSM 3 hemoximeter (Radiometer): 8% (n= 33) of 415 neonates were found to be methb positive (denned as ≥6% methb). Mean methb was 19% (range 6.5–45.5%). Maximum methb concentrations were found on day 4–31 postpartum (mean 12 days) and the number of days with a positive methb sample ranged from 1 to 18 days (mean 6 days). About 40% of the neonates born at 25–30 weeks of gestation and 60%) with a birth weight < 1000 g were methb positive. Also, there was a negative correlation between the size of the methb positive concentration and gestational age (r=– 0.38,p= 0.02). Measurements of C–reactive protein and leucocytes, NADH reductase, pH, CI, nitrate and nitrite were carried out in methb positive patients. The tests were repeated 1 week after cessation of methb. The only significant difference was an increase in NADH reductase at the second measurement. Likewise, a wide range of clinical parameters were registered and they occurred with a higher frequency among the methb positive patients when compared with a methb negative control group matched with regard to gestational age and the closest possible birth weight. The mean birth weight of methb positive patients was 1170g and that of negative controls 1380g (p < 0.006). Epidemiological data and intervention studies indicated that para–chloraniline was the direct cause of the epidemic. The substance was derived from 0.02% chlorhexidine being inadvertently added to the humidifying fluid of the new incubators. Treatment of severe methb in premature neonates with 0.3–1.0mg methylene blue/kg body weight proved efficient. In conclusion, premature neonates developed severe methb when exposed to even small amounts of para–chloraniline. Immaturity, severe illness, the time exposed to para–chloraniline and low concentrations of NADH reductase probably played a part while other well known factors such as increased nitrite and nitrate concentrations, acidosis and hyperchloraemia did not seem to be significant.
Arterial oxygen saturation in infants at risk of sudden death: influence of sleeping position
Authors: Poets CF , Rudolph A , Neuber K , Buch U , Von Der Hardt H
Published: January 2008

To study the possible influence of sleeping position on arterial oxygen saturation, measured by pulse oximetry (Sp62), 7–h overnight recordings of breathing movements and ECG were performed in 43 infants (median age 2.4 months, range 0.2–11 months) at increased risk of sudden infant death syndrome (SIDS). Infants were randomly allocated to start sleeping either in their usual sleeping position or in the opposite position. After 3.5 h, all infants were gently turned over. Thus, each infant served as their own control. Recordings were analysed for sleep time, baseline Sp02 (only during regular breathing), and the number and duration of desaturations (a decrease in Sp02 to ≤80%). In the prone position, a significantly higher proportion of time was spent asleep (median 79% versus 70%;p < 0.05). Median baseline Sp02 was 98.8% (91.7–100%) in the prone and 99.0% (92.0–100%) in the supine position (ns). A total of 191 desaturations were found in 29 recordings; 96 in the prone and 95 in the supine position (ns). One infant subsequently died of SIDS while sleeping in the prone position. He had a relatively high number of desaturations (n = 12) which all occurred in the prone position. These results confirm earlier studies which could not find a significant influence of sleeping position on baseline oxygenation. The occurrence of desaturations in the prone position only in the infant who subsequently died requires further investigation.
Dietary calcium, saturated fat, fiber and vitamin C as predictors of forearm cortical and trabecular bone mineral density in healthy children and adolescents
Authors: Gunnes M , Lehmann EH
Published: January 2008

Diet, weight–bearing physical activity (WPA) and daylight hours spent outdoors (DE) were related to bone mineral density in the distal (BMDd) and ultradistal (BMDud) forearm of 495 healthy children (8–11 years) and adolescents (11–17 years). BMD was assessed by single photon absorptiometry. Using multiple regression, BMDd was predicted by saturated fat and BMDud by fiber in children. In adolescents, BMDd was predicted by saturated fat and vitamin C, and BMDud by calcium and vitamin C. WPA and DE were not related to BMD. In conclusion, our results showed that current intake of calcium, saturated fat, fiber and vitamin C were positively associated with forearm BMD in children and adolescents. These associations depended on age and bone type. If our findings are verified, dietary recommendations, especially when aimed at young people, may have to be reconsidered.
Assessment of an abbreviated odorant identification task for children: a rapid screening device for schools and clinics
Authors: Richman RA , Wallace K , Sheehe PR
Published: January 2008

To validate the level of olfactory performance of children, we tested 825 volunteers, aged 4–17 years, with an abbreviated form of our pediatric odorant identification task. The test consisted of sniffing and identifying five odorants (baby powder, bubble gum, candy cane, licorice and peach). Mean olfactory scores increased as a function of age, reaching a plateau of about 94–95% correct at 8 years of age. In general, girls out–performed boys. Physicians require a test instrument such as the one we have devised to allow them to diagnose olfactory dysfunction in children. The present task is particularly applicable in screening large numbers of children in clinics or schools because it can be administered easily and rapidly. Adult subjects with olfactory dysfunction also performed poorly on this odorant identification task designed for children. Therefore, we expect that our odorant identification task will also detect children with severe olfactory dysfunction.
Two cases suggesting a role for the L–arginine nitric oxide pathway in neonatal blood pressure regulation
Authors: Fakler CR , Kaftan HA , Nelin LD
Published: January 2008

Endogenous nitric oxide produced from L–arginine is a potent vasodilator that may be involved in blood pressure regulation. A male infant with argininosuccinate lyase deficiency, who could not synthesize L–arginine, was hypertensive prior to L–arginine replacement. The infusion of L–arginine resulted in a decrease in blood pressure. A three–fold increase in the dose of L–arginine further decreased blood pressure. On discontinuing the infusion of L–arginine, the patient's blood pressure increased. A female infant undergoing an L–arginine challenge test had a decrease in blood pressure during L–arginine infusion which resolved when the L–arginine infusion was discontinued. These two cases suggest that nitric oxide production from L–arginine may play a role in the normal regulation of systemic blood pressure.
Subsequent pregnancy affects nutritional status of previous child: a study from Bhutan
Authors: Bøhler E , Singey J , Bergström S
Published: January 2008

In a rural area of Bhutan, anthropometric measurements of 113 children and interviews with their mothers were carried out monthly for 32 months. The purpose of the study was to investigate the effect of a mother's subsequent pregnancy on growth in weight of her last–born child. The children whose mothers had a subsequent birth interval of 18–30 months were matched for date of birth with children whose mothers did not become pregnant. Growth of the children during the subsequent pregnancy was compared with growth during the same period of children whose mothers were not pregnant. A statistically significant reduction of 28% was found (p < 0.05), which was most pronounced in early pregnancy. A similar trend was found for change in mid–upper–arm circumference (p < 0.05). The study provides evidence of a causal relationship between a moderate subsequent pregnancy interval and a concurrent reduction in growth rate for the previous child
Urinary excretion of aldosterone, arginine vasopressin and Cortisol in premature infants with maximum renal acid stimulation
Authors: Kalhoff H , Rascher W , Diekmann L , Stock GJ , Manz F
Published: January 2008

Of 452 low–birth–weight infants who were routinely screened for maximum renal acid stimulation (MRAS) (urine pH < 5.4), 149 episodes of incipient late metabolic acidosis (urine pH < 5.4 on 2 consecutive days) were randomly allocated to either a control group or treatment with NaHCO3 or NaCl (2 mmol/kg/day each) for 7 days. Urinary excretion of aldosterone–18–glucuronide (Aldo), arginine vasopressin (AVP) and Cortisol was determined in timed urine samples. On day 1, patients with MRAS showed a tendency towards increased urinary excretion of Aldo compared with infants without MRAS. In patients who received alkali therapy, urinary excretion of Aldo, AVP and Cortisol decreased or showed a trend to lower values from day 1 to day 7, whereas in patients with MRAS but no specific therapy, Aldo and AVP showed a tendency to increase. We concluded that persistent MRAS is not only characterized by a reduced rate of weight gain and a tendency to decreased nitrogen assimilation, but also increased secretion of Aldo and AVP.
Release of xanthine oxidase to the systemic circulation during resuscitation from severe hypoxemia in newborn pigs
Authors: Rootwelt T , Almaas R , øyasster S , Moen A , Saugstad OD
Published: January 2008

Xanthine oxidase may contribute to oxygen free radical formation during reoxygenation after hypoxia, but in humans the enzyme is present in substantial amounts only in the liver and intestine. We developed a sensitive assay for xanthine oxidase using 14C–xanthine as substrate and investigated whether xanthine oxidase was released into the systemic circulation when 19 newborn pigs were resuscitated after severe hypoxemia. In five piglets plasma xanthine oxidase concentrations increased from undetectable levels to a median value of 8 (range 4–18) μU/ml after 30 min of reoxygenation. In these pigs serum aspartate aminotransferase increased from 45 to 148 U/l, while alanine aminotransferase was unchanged (28–31 U/l). The release of xanthine oxidase did not seem to correlate with the severity of the histological brain damage after 4 days. We conclude that only low levels of xanthine oxidase are released to the systemic circulation after severe hypoxemia in newborn pigs.
Relationship between height, sitting height and subisehial leg length in Dutch children: presentation of normal values
Authors: Gerver WJM , Bruin R De
Published: January 2008

A widely used method of judging body proportions is to consider the ratio of sitting height to height (SH/H) related to age. A drawback of this method is that only one derived variable is used. A pairwise consideration of the original measurements provides more information. In this study data from the cross–sectional Oosterwolde I growth study are used to present normal values for the ratio SH/H for age, as well as values for sitting height related to height and subisehial leg length. A comparison is made with other studies.
Auxological, clinical and neuroradiological findings in infants with early onset growth hormone deficiency
Authors: Luca F De , Bernasconi S , Blandino A , Cavallo L , Cisternino M
Published: January 2008

Sixteen infants less than 2 years of age with apparently idiopathic hypopituitarism were studied. At birth, 11 of 16 patients (69%) had subnormal length associated with relative adiposity and 10 of 16 (62%) showed significant deterioration in length deficiency from birth onwards. These findings suggest that: (a) growth hormone deficiency, in a number of patients, had started well before delivery; (b) growth hormone may play a role in intrauterine growth; and (c) growth hormone may also be involved in early postnatal growth. Magnetic resonance imaging in these patients was very similar to that described in hypopituitarism of later onset. This suggests that even in the latter case, hypopituitarism may have a prenatal onset. Finally, the severity of growth failure and the coexistence of other hypopituitary symptoms at the time of diagnosis in 31 % of our patients indicate that early clinical screening of hypopituitarism is possible.
Cystic fibrosis, pancreatic sufficiency and distal intestinal obstruction syndrome: a report of four cases
Authors: Millar‐Jones L , Goodchild MC
Published: January 2008

Distal intestinal obstruction syndrome (DIOS), formerly termed meconium ileus equivalent, is usually considered to be unique to cystic fibrosis (CF) patients who have steatorrhoea. We report four CF patients without steatorrhoea (“pancreatic sufficient”) who have had repeated episodes of faecal loading indistinguishable from DIOS.
Maternal perceptions of neonatal care
Authors: Redshaw ME , Harris A
Published: January 2008

In a large‐scale study of neonatal care in England, hospital and questionnaire data were collected on the experiences of an unselected group of 420 mothers whose babies had recently been admitted for neonatal care to one of 23 widely distributed hospitals. Perceptions of their infant while in the neonatal unit differed in relation to gestational age, whether or not the baby required assisted ventilated, the mother's own health and if she had previously had a baby cared for in this way. This investigation of how mothers see and adjust to their small, sick baby in the neonatal unit confirmed the crisis nature of the birth and admission, and provides insights for staff and other health professionals about the salient issues for parents at this time.
Pulse oximetry in ventilated preterm newborns: reliability of detection of hyperoxaemia and hypoxaemia, and feasibility of alarm settings
Authors: Paky F , Koeck CM
Published: January 2008

The aim of our study was to evaluate the reliability of pulse oximetry in detecting both hyper‐ and hypoxaemic states and to create clinically feasible alarm limits. A total of 792 readings of a pulse oximeter and corresponding values of arterial oxygen tension from 146 (79M, 67F) artificially ventilated preterm newborns with indwelling umbilical artery catheters were compared. Predictive value analysis of pulse oximeter readings related to arterial oxygen tension confirmed the ability of the pulse oximeter to identify both hypoxaemia and hyperoxaemia. However, a clinically feasible and safe range of alarm limits for maintenance of arterial oxygen tension of 40‐90 mmHg (5.3‐12kPa) could only be established at a sensitivity level less than 0.9. At a level of 0.85, the alarm range on the pulse oximeter was 92.5‐95%. Based on these findings, we are concerned about using pulse oximetry as the sole means of oxygen monitoring for preterm infants receiving supplementary oxygen. A combination of the pulse oximetry with other methods of blood‐gas monitoring seems mandatory