bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum bilirubin levels at 72 hours by selected characteristics in breastfed and formula‐fed term infants delivered by cesarean section
Authors: Hintz SR , Gaylord TD , Oh W , Fanaroff AA , Mele L , Stevenson DK ,   NICHD, Neonatal Research Network
Published: August 2010

The present multicenter study analysed the relative impact of maternal and infant factors on serum bilirubin levels at 72 ± 12 h in exclusively breastfed vs formula‐fed term infants. End‐tidal carbon monoxide levels corrected for ambient air (ETCOc), an index of bilirubin production, were measured in exclusively breastfed (B = 66) or formula‐fed (F = 210) term infants at 2–8 h of age. Inclusion criteria included cesarean section to ensure a 3 d hospitalization, birthweight ±2500 g, gestational age ±37 wk and absence of any illness. The ETCOc for B infants and F infants did not differ significantly (1.3 ± 0.7 ppm vs 1.3 ± 0.8 ppm). The serum bilirubin level at 72 ± 12 h was significantly higher in B infants than in F infants (8.5 ± 3.4mg dl−1 vs 6.7 ± 3.4 mg d l−1, p < 0.001), as was the percentage weight loss from birthweight. Serum bilirubin levels were significantly higher in infants who were male, who did not have meconium‐stained amniotic fluid, and in those whose mothers were insulin‐dependent diabetics or hypertensive. There was no difference between groups in the need for phototherapy or exchange transfusion.

Conclusion: Although higher bilirubin levels were observed in group B at 72 ± 12 h compared with group F, this finding was not of clinical or therapeutic consequence in this study. The lack of difference in ETCOc between the groups may be a factor of the timing of ETCOc measurement in this study, or may suggest that early increased bilirubin production is not a significant contributor to jaundice observed in exclusively breastfed infants.
Transcutaneous‐PO2 monitoring for detection of exercise‐induced right‐to‐left shunts in children with congenital heart defects: A case report
Authors: Holmgren D , Redfors S , Solymar L
Published: August 2010

A 2‐y‐old boy with scimitar syndrome underwent surgery involving the redirection of partial anomalous pulmonary venous return to the left atrium. Heart catheterization after the operation did not reveal any significant intra‐cardiac shunts. An exercise test performed at the age of 10 y revealed a reduction in working capacity. At the age of 12 y, the patient became unconscious and experienced seizures during heavy physical exercise. EEG and Holter ECG examinations were normal. In a second exercise test, a fall in transcutaneous PO2 was demonstrated at the start of the test. A new heart catheterization revealed communication between the inferior vena cava and the left atrium owing to a misplaced patch. No right‐to‐left shunt was found at rest, probably as a result of drainage of the inferior vena cava to the superior vena cava by the azygous vein. An exercise test after re‐operation revealed normal conditions.

Conclusion: Haemodynamic studies during heart catheterization in children are usually performed at rest. This could result in exercise‐induced right‐to‐left‐shunts being overlooked. The use of PtcO2 monitoring during exercise tests is a non‐invasive means of exposing these shunts.
Integration of vitamin A supplementation with the Expanded Programme on Immunization: lack of impact on morbidity or infant growth
Authors: Semba RD , Munasir Z , Akib A , Melikian G , Permaesih D , Muherdiyantiningsih D , Marituti S , Muhilal S.
Published: August 2010

Vitamin A deficiency is associated with increased morbidity and mortality from diarrheal disease, measles, and malaria. It has been proposed that vitamin A supplementation could be linked with childhood immunization programs to improve child health. We conducted a randomized, double‐blind, placebo‐controlled clinical trial to evaluate the impact of linking vitamin A supplementation with the Expanded Programme on Immunization on morbidity and child growth. In West Java, Indonesia, 467 six‐week‐old infants were randomized to receive 7.5 mg retinol equivalent (RE), 15 mg RE, or placebo with childhood immunization contacts at 6, 10, and 14 wks and 9 mo of age. Child growth was assessed through anthropometry, and morbidity histories were obtained. Vitamin A supplementation had no apparent impact upon linear or ponderal growth or infectious disease morbidity in the first 15 mo of age when integrated with the Expanded Programme on Immunization.

Conclusion: Although improving vitamin A nutriture is of general importance in reducing diarrheal and measles morbidity and mortality in developing countries, this clinical trial showed no apparent benefit of vitamin A capsules for infant health when given through childhood immunization programs.
Pancreatic beta‐cell stimulation tests in transient and persistent congenital hyperinsulinism
Authors: Christesen HBT , Feilberg‐Jørgensen N , Jacobsen Brock
Published: August 2010

In congenital hyperinsulinism (HI), the in vivo pancreatic β‐cell function is poorly described. Among 14 neonates with severe hyperinsulinaemic hypoglycaemia, 2 patients had very prolonged or persistent hypoglycaemia and mutation in the sulphonylurea receptor SUR1 gene. Patient 1 had transient HI and was treated medically for 3.5 mo before clinical remission was seen. He had initially very high basal and stimulated C‐peptide and insulin levels, followed by a state of normal preprandial values, but blunted β‐cell glucose sensitivity, before complete β‐cell normalization occurred. A single, paternal SUR1 mutation, G1382S, was found suggesting focal type HI. Patient 2 had persistent HI and underwent 3 pancreas resections up to the age of 2 y, 7 mo, followed by a state of mild diabetes. On biopsy, diffuse‐type β‐cell hypertrophy was seen. The β‐cell response to glucose and glucagon stimulation was blunted before, as well as after, pancreas resections. Compound heterozygosity for the SUR1 mutations 3992–3c to g and N188S was found.

Conclusion: Transient, possibly focal, HI with paternal SUR1 mutation was associated with a gradual, but complete normalization of the in vivoβ‐cell function; in the diffuse type HI, a blunted β‐cell response to glucose and glucagon stimulation persisted. In vivoβ‐cell stimulation tests may contribute to the characterization of the HI subtypes.
Muscle power in “high‐risk” preterm infants at 12 and 24 weeks corrected age: a measure for early detection
Authors: Samsom JF , de Groot L , Hopkins B
Published: August 2010

A group of 72 “high‐risk” preterm infants was studied at the corrected ages of 12 and 24 wk. Only infants with a high risk for developmental deviance with gestational ages below 32 wk and/or birthweights of less than 1500 g were included in the study. In addition, the infants were categorized according to their medical history, as confirmed by the “Neonatal Medical Index” (NMI I to V), with category I describing infants with few medical problems and V characterizing those with the most serious complications. In this study we included only “high‐risk” infants as categorized in NMI III to V, since infants with a “low risk” have been described earlier. Apart from the standard paediatric follow‐up, an age‐adequate neurological assessment was made, with special emphasis on the relationship between active and passive muscle power. When development is optimal, these two components of muscle power should be in balance in order to create a stable posture and fluent motility. We compared muscle power at the corrected ages of 12 and 24 wk to determine whether the method employed to assess muscle power could enhance early detection of deviant development. At 12 wk of age, only 5 infants showed overall optimal muscle power, while at 24 wk this figure had increased to 27. Significantly more infants in NMI III had optimal outcomes at 24 wk of age. When muscle power in the different parts of the body was studied separately at 24 wk, outcomes in shoulders and trunk still showed significant discrepancies in all NMI groups. At this age, fewer asymmetries were found compared to outcomes at 12 wk.

Conclusion: Our method of assessing muscle power is useful in detecting preterm infants at risk for pathological development.
Cord blood levels of cytokines as predictors of early neonatal sepsis
Authors: Santana C , Guindeo MC , González G , García‐Muñoz F , Saavedra P , Doménech E
Published: August 2010

Aim: To investigate whether cord blood levels of C‐reactive protein, interleukin‐1β, interleukin‐6, interleukin‐8, tumour necrosis factor‐α and the soluble receptor of interleukin‐2, are useful markers in the diagnosis of early neonatal sepsis. Design: Umbilical cord blood samples were obtained at birth from 261 neonates, but 5 of these newborns were excluded from the study. Group I included 10 newborns that developed early neonatal sepsis with a positive blood culture; Group II included 11 newborns with non‐infectious perinatal diseases; Group III, which served as the control group, included 10 randomly selected patients, matched for gestational age, among the 235 healthy newborn babies. Results: There were no differences among the three study groups in levels of C‐reactive protein, interleukin‐1 β, tumour necrosis factor‐α and the soluble receptor of interleukin‐2. Interleukin‐6 was significantly elevated in Group I (360.4 ± 157.8 pg/ml) and Group II (158.8 ± 122.3 pg/ml), when compared with Group III (8.6 ± 3.12 pg/ml) (p < 0.01), whereas interleukin‐8 was significantly elevated in Group I (389.3 ± 115.9 pg/ml) compared with Groups II (30.2 ± 5.1 pg/ml) (p < 0.05) and III (33.9 ± 8.6 pg/ml) (p < 0.05). A cut‐off of 100.8 pg/ml for interleukin‐6 obtained by the ROC (receiver operating characteristic) method gave a sensitivity of 50% and a specificity of 87%, and a cut‐off of 111.7 pg/ml for interleukin‐8 showed a sensitivity of 78% and a specificity of 91%.

Conclusion: While cord blood levels of interleukin‐6 appear to be related to pathological conditions in the perinatal period (infectious and non‐infectious), interleukin‐8 seems to be a good predictor of early bacterial neonatal infection.
Genetic variants of the tumour necrosis factor‐alpha promoter gene do not influence the development of necrotizing enterocolitis
Authors: Treszl A , Kocsis I , Szathmari M , Schuler Á , Tulassay T , Vásárhelyi B
Published: August 2010

Previous studies indicated that elevated tumour necrosis factor‐alpha (TNF‐α) levels may play a role in the development of necrotizing enterocolitis (NEC). The A–238 and A–238 variants of the promoter region of the TNF‐α gene are reportedly associated with altered TNF‐α production. The aim of our study was to determine the impact of these gene polymorphisms on the development and course of NEC in very‐low‐birthweight (VLBW) infants. Dried blood samples from 46 VLBW neonates with NEC were analysed using the method of restriction fragment length polymorphism. Samples from 90 VLBW neonates without NEC were used as controls. The prevalence of alleles with guanine‐adenine transition in the –308 and –238 positions was the same in NEC and control subjects (12% vs 10% and 3% vs 4%, respectively).

Conclusion: The investigated genetic variants of the TNF‐α gene promoter region have no influence on the risk and course of NEC in VLBW infants.
A relatively low prevalence of Helicobacter pylori infection in a healthy paediatric population in Riga, Latvia: a cross‐sectional study
Authors: Daugule I , Rumba I , Lindkvist P , Bergström M , Ejderhamn J
Published: August 2010

The aim of this study was to investigate the prevalence, age of acquisition and risk factors for Helicobacter pylori (H. pylori) among asymptomatic children. 13C‐urea breath tests and questionnaires were obtained from 142 children and 40 parents. The prevalence of H. pylori was 19%. H. pylori positivity was higher in children with a positive parent (p= 0.003) and independently inversely related to antibiotic treatment during the previous year in preschool children (p= 0.045).

Conclusion: The prevalence of H. pylori in children in Riga is higher than that in Western countries, but lower than that in Eastern European countries. H. pylori is present during the second year of life and is influenced by parental H. pylori status and previous treatment with antibiotics.
Potentiation of vincristine toxicity by itraconazole in children with lymphoid malignancies
Authors: Kamaluddin M , McNally P , Breatnach F , O'Marcaigh A , Webb D , O'Dell E , Scanlon P , Butler K , O'Meara A
Published: August 2010

Eight consecutive paediatric patients with acute lymphoblastic leukaemia (ALL) (n=7) and T‐cell non‐Hodgkin's lymphoma (NHL) (n=1) presenting within a 5‐wk interval were started on a standard induction protocol which included weekly treatment with vincristine for 4 wk. Itraconazole was commenced as antifungal prophylaxis, 1–21 d after the first injection of vincristine. Within 2 to 4 wk, enhanced vincristine neurotoxicity was noted in all patients, abdominal cramps and constipation occurred most frequently, and one patient developed a bowel perforation associated with paralytic ileus. Hyponatraemia associated with SIADH was observed in three patients and four patients developed seizures. An additional patient with B cell NHL developed seizures 5 d after an injection of vincristine. Recovery was complete in all patients and ranged from 2 d to 15 wk.

Conclusion: The extent and consistency of adverse effects documented in this study support the recommendation that concurrent administration of vincristine and itraconazole should be avoided.
Whole‐body mineral measurements in Swedish adolescents at 17 years compared to 15 years of age
Authors: Bratteby L‐E , Samuelson G , Sandhagen B , Mallmin H , Lantz H , Sjöström L
Published: August 2010

Aim: To provide reference data for bone mineral variables in 15‐ and 17‐y‐old adolescents and to analyse the relationships between these variables and measures of bone and body size, gender, puberty, growth, various lifestyle and environmental factors and socioeconomic background. Methods: In the same 321 randomly selected adolescents (147 boys and 174 girls) living in two different regions of Sweden, the total bone mineral content (TBMC), bone area (BA) and total bone mineral density (TBMD) were assessed by dual‐energy X‐ray absorptiometry at ages 15 and 17 y. The effects of bone and body size, gender, growth, sexual maturity, physical activity, region of domicile, social conditions, food habits, smoking and alcohol intake on TBMC and TBMD were examined in multivariate analyses. Results: In the 15‐y‐old adolescents, BA, height, gender, physical activity, maturity and weight explained 91% and 48%, of the variance in TBMC and TBMD, respectively. In similar analyses in the 17‐y‐olds, the corresponding figures were 92% and 62%, respectively, when BA, height, growth, physical activity, gender and region emerged as significant in the model. In all these analyses, BA explained most of the variance in TBMC and TBMD. No significant reduction of variance was found when different measures of social conditions, smoking, food habits, alcohol or dietary intakes of energy, calcium or vitamin D were included in the models. The reason why region of domicile had a significant impact on TBMC in the 17‐y‐olds is not known. The fact that the normal fluoride concentration in drinking water (1.1 mg/L) is 10 times higher in the region where TBMC was higher than in the other region is an interesting observation.

Conclusion: Almost 90% of the variance in TBMC and 50% of that in TBMD was explained by measures of bone and body size and only a few percent by gender, physical activity, Tanner stage, growth and region of domicile.
Extremely high prevalence of hypercalciuria in children living in the Aral Sea region
Authors: Kaneko K , Chiba M , Hashizume M , Kunii O , Sasaki S , Shimoda T , Yamashiro Y , Dauletbaev D , Caypil W , Mazhitova Z
Published: August 2010

The Aral Sea region is a natural area seriously polluted by human activities. In addition to the increased prevalence of diverse chronic diseases in children, the risk of developing urolithiasis is reported to be high in this region. This study was undertaken to clarify the prevalence of hypercalciuria in children of the Aral Sea region. A group of 205 children living in Kazalinsk, close to the Aral Sea, and a group of 187 children living in Zhanakorgan, far from the Aral Sea, were screened for hypercalciuria. Urinary sodium excretion (sodium per creatinine, uNa/Cr) in addition to calcium excretion (calcium per creatinine, uCa/Cr) was also calculated for each subject. Mean uCa/Cr (mmol/mmol) and uNa/Cr (mmol/mmol) excretions were significantly higher in Kazalinsk than in Zhanakorgan (uCa/Cr: 0.75 ± 0.74 and 0.33 ± 0.30; uNa/Cr: 3.54 ± 2.27 and 2.89 ± 1.69, respectively, mean ± SD, p < 0.01). Hypercalciuria regarded as an uCa/Cr of more than 0.703 was observed in 79 out of 205 Kazalinsk children (38.6%) while this was seen in only 24 out of 187 Zhanakorgan children (12.8%). Linear regression analysis revealed a direct positive correlation between urinary calcium and sodium excretion (p < 0.01) in Kazalinsk children.

Conclusion: The prevalence of hypercalciuria in children around the Aral Sea region is extremely high. This may be associated with excessive intake of calcium and sodium, or due to impaired renal tubular function caused by toxic chemicals. Therefore, hypercalciuria that may lead to urolithiasis should be taken into account when considering the health problems of this area.
Enuresis, sleep and desmopressin treatment
Authors: Nevéus T , Bader G , Sillén U
Published: August 2010

Aim: To detect effects of desmopressin on sleep in enuretic children and to look for polysomnographical differences between responders and non‐responders to desmopressin treatment. Methods: Twenty‐one children with primary nocturnal enuresis were examined polysomnographically before treatment. All but one of the children then received treatment with desmopressin in standard dosage, and the response was documented. Seven of the children underwent a second polysomnographic registration while on treatment. Results: The time interval (±1 SD) between sleep onset and the enuretic episode was 92 ± 67 min without medication and 372 ± 157 min when desmopressin was given (p= 0.003). Standard polysomnographic variables were not affected by the drug. Ten children were desmopressin responders and 10 were non‐responders. The total sleep time was 455 ± 56 min in the former and 408 ± 31 min in the latter group (p= 0.04). The responders spent 27.4 ± 5.5% of their total sleep time in rapid eye movement sleep, compared with 18.2 ± 6.5% in the non‐responder group (p= 0.004).

Conclusion: Desmopressin has no major effects on sleep as such but does delay bladder emptying. Enuretic children responding to desmopressin treatment have more rapid eye movement sleep than therapy‐resistant children.
Small bowel biopsy in Swedish paediatric clinics
Authors: Stenhammar L , Ascher H , Danielsson L , Dannaeus A , Hernell O , Ivarsson A , Lindberg E , Lindquist B , Nivenius K
Published: August 2010

Aim: A correct diagnosis of coeliac disease, one of the most common chronic diseases in Swedish children, demands small bowel biopsy, which can be performed endoscopically or by means of a peroral capsule. Recently there was a debate among Swedish paediatric gastroenterologists, with some advocating the cessation of capsule biopsy in favour of endoscopic biopsies. To gain information on which to base a recommendation for which technique to use, the Swedish Working Group for Childhood Coeliac Disease was commissioned to carry out a national questionnaire study on current small bowel biopsy routines in Swedish paediatric clinics. Methods: A questionnaire concerning biopsy routines in the year 2000 was sent to all paediatric clinics performing biopsies. A reply was obtained from 39 of 40 clinics, covering 98% of the Swedish population. Results: Some 1400 biopsies were performed, 64% of which were capsule biopsies and 36% endoscopic. Three clinics performed all biopsies endoscopically and 11 clinics all via a capsule. At endoscopy all children were under deep sedation or full anaesthesia, while most children undergoing capsule biopsy were under light or deep sedation. The oxygen saturation was monitored during endoscopy but less often or never during routine capsule biopsy. The presence of the parents during biopsy varied according to the degree of sedation: at 97% of the clinics performing capsule biopsy on children under light sedation, the parents were present during the whole procedure, whereas no parents were present at clinics where the biopsy was performed endoscopically under anaesthesia.

Conclusion: Compared with the results of a similar questionnaire concerning biopsy routines performed in the early 1990s, children are now more effectively sedated. Furthermore, there is an obvious trend from capsule towards endoscopic biopsy. Both the endoscopic and the capsule biopsy techniques are useful and satisfactory for obtaining small bowel mucosal samples providing that the children are effectively sedated. For practical and economic reasons the capsule biopsy technique will probably continue to be used, although to a lesser extent than today.
Recurrent pneumonia in children: clinical profile and underlying causes
Authors: Lodha R , Puranik M , Natchu UCM , Kabra SK
Published: August 2010

Aim: To study the clinical profile and describe the predisposing causes of recurrent pneumonia in Indian children. Methods: The clinical details and the investigations of children presenting with recurrent pneumonia to the paediatric chest clinic services of a tertiary care centre in northern India were reviewed. Results: Seventy children (44M, 26F) presented with recurrent pneumonia over a period of 5 y. Based on the clinical features and the results of the investigations, underlying illness could be identified in 59 children (84%). The most frequent underlying cause for recurrent pneumonia was recurrent aspiration (24.2%), followed by immunodeficiency (15.7%), asthma (14.2%) and structural anomalies (8.6%).

Conclusion: The underlying cause of recurrent pneumonia was identified in more than 80% of children. Recurrent aspirations were the most common cause.
Surfactant improves oxygenation in infants and children with pneumonia and acute respiratory distress syndrome
Authors: Herting E , Möller O , Schiffmann J‐H , Robertson B
Published: August 2010

Aim: Pneumonia in childhood may be associated with surfactant dysfunction and severe acute respiratory distress syndrome (ARDS). The aim of this study was to investigate the effects of surfactant treatment on oxygenation in 8 infants (age range: 1 mo to 13 y) with severe respiratory failure owing to viral, bacterial or Pneumocystis Carinii pneumonia. Methods and results: Instillation of a modified porcine surfactant (Curosurf®) improved gas exchange immediately. Median paO2/FiO2 increased from 66 to 140mmHg (8.8–18.7 kPa; p < 0.01) within 1 h of surfactant treatment. Seven of the 8 patients received multiple surfactant doses. Four patients (50%) died 3–62 d after surfactant treatment. However, 6 patients (75%) were immunodeficient, so that the observed mortality rate was mainly due to the underlying disease.

Conclusion: Surfactant dysfunction probably plays a role in the pathophysiology of severe paediatric ARDS triggered by pneumonia, as it was found that surfactant instillation rapidly improved gas exchange in the majority of the affected infants in our study. Larger randomized controlled studies are necessary to evaluate the effects of surfactant treatment on morbidity and mortality.
Follow‐up into young adulthood after cardiopulmonary resuscitation in term and near‐term newborn infants. II. Neuropsychological consequences
Authors: Viggedal G , Lundälv E , Carlsson G , Kjellmer I
Published: August 2010

Aim: Brain injury after neonatal cardiopulmonary resuscitation in the term baby is often described as an all‐or‐nothing phenomenon, but little is known about possible late cognitive consequences. The aim of this study was therefore to investigate whether children who needed cardiopulmonary resuscitation because of presumed mild and moderate intra‐partum asphyxia with no evidence of neurological impairments at 18 mo of age may display neuropsychological impairments later in life. Methods: A long‐term follow‐up of young adults was carried out. A blinded comprehensive neuropsychological assessment of the main aspects of cognitive functions was made. The subjects who were resuscitated were divided into two groups according to the clinical course: 20 cases with mild asphyxia and 11 cases with moderate asphyxia, all followed prospectively and compared with 18 healthy controls. The 31 subjects were born at term or near‐term and selected randomly from 59 infants born in 1969–1978 at Sahlgren's Hospital, Göteborg. All infants with early neurological impairments were excluded. Results: No major differences could be established between the two clinical groups and normal controls in any aspects of cognitive function or intelligence. All the groups performed within the normal range in all tests. A tendency toward minor deficits in verbal ability in the mild group compared to the controls was found. Only one subject had a clear, defined memory deficit.

Conclusions: Infants who underwent cardiopulmonary resuscitatation at birth without neurological deficits at 18 mo of age did not show any cognitive deficits or neuropsychological impairments in adulthood even though inferior performance on some verbal subtests was observed compared to the control group.
Lack of effect of the European guidance on clinical investigation of medicines in children
Authors: Jong GW‘t , Strieker BHCh , Choonara I , van den Anker JN
Published: August 2010

Aim: To evaluate the registration for paediatric use of new chemical entities (NCEs) granted a marketing authorization (product licence). Methods: European Public Assessment Reports (EPARs) published on the Internet from January 1995 to May 2001 were analysed. Results: Of 120 new substances licensed since January 1995, 70 (58%) were of potential use in children. Of these, only 17 were licensed for all paediatric uses, and 15 for some paediatric age groups. Hence, the majority (54%) of these substances were probably not tested in paediatric age groups.

Conclusion: Many of the new drugs granted marketing authorization lack sufficient paediatric labelling. The proportion of drugs for which full labelling was available has not increased in recent years. The European Medicines Evaluation Agency should make an effort to improve this I situation.
Measles virus genome detected up to four months in a case of congenital measles
Authors: Nakata Y , Nakayama T , Ide Y , Kizu R , Koinuma G , Bamba M
Published: August 2010

To determine how long the measles virus genome was detected in a patient with congenital measles, the peripheral blood mononuclear cells were tested for 203 d. The measles virus genome was detected up to 140 d.

Conclusion: The period for which the measles virus genome was detected in this patient with congenital measles was much longer than in normal children with measles.
Role of platelet‐activating factor in the pathophysiology of necrotizing enterocolitis
Authors: Ewer AK
Published: August 2010

Necrotizing enterocolitis (NEC) is a devastating gastrointestinal illness that affects predominantly preterm infants. Treatment options are limited and NEC remains a significant cause of morbidity and mortality. The precise aetiology of NEC remains unclear but evidence strongly suggests that the cause is multifactorial and there are four main aetiological factors: prematurity, hypoxia, enteral feeding and bacterial colonization. The presence of similar intestinal lesions, regardless of aetiological trigger, strongly implicates a final common pathway in the pathogenesis. There is now a substantial body of evidence to indicate that endogenous inflammatory mediators, particularly platelet‐activating factor (PAF), play a vital role in this final pathway.

Conclusion: The use of agents that antagonize PAF may provide therapeutic options in the management of NEC.
Respiratory mechanical unloading and proportional assist ventilation in infants
Authors: Schulze A
Published: August 2010

Conventional patient‐triggered ventilation attempts to synchronize the upstroke in ventilator pressure with the onset of spontaneous inspiration. Other parameters of the mechanical cycle such as the peak inspiratory pressure are preset by the clinician. They will be imposed on the infant regardless of the actual spontaneous respiratory drive. Proportional assist ventilation (PAV) and respiratory mechanical unloading of spontaneous breathing (RMU, resistive and elastic unloading) are based on fundamentally different concepts. In contrast to the conventional perception of the ventilator being a pump, RMU/PAV servo‐controls the applied ventilator pressure continuously throughout each inspiration. These modalities proportionally enhance the effect on ventilation of each respiratory effort. They rely on rather than interfere with the subject's respiratory control system. The patient controls all variables of the respiratory pattern while the ventilator works fully enslaved as a proportional amplifier. Back‐up conventional mechanical ventilation is initiated during episodes of hypo ventilation and apnoea. The clinician sets the degree of the assist during RMU/PAV in terms of “gains”. Selecting specific gains for the elastic and resistive unloading components allows the ventilator pressure waveform to be tailored to the individual degree of restrictive and obstructive pulmonary disease. This results in a reduction in the transpulmonary pressure cost of ventilation compared with conventional modes.

Conclusion: Further studies on RMU/PAV are required to evaluate clinically important long‐term outcome variables in infants and to determine whether the benefits outweigh potential drawbacks and the complexity involved in these new modes of mechanical ventilation.
Different quantities and quality of fat in milk products given to young children: effects on long chain polyunsaturated fatty acids and trans fatty acids in plasma
Authors: Svahn JCE , Feldl F , Räihä NCR , Koletzko B , Axelsson IEM
Published: August 2010

In this study we compared plasma contents of long‐chain polyunsaturated fatty acids (LC‐PUFAs) and trans fatty acids in triglycerides (TG), phospholipids (PL) and cholesterolesters (CE) in young children fed milk diets containing different amounts of linoleic (LA) and α‐linolenic acid (ALA). Because the diets differed in vitamin A and E content, plasma concentrations of vitamin A and E were also studied. Thirty‐seven 1‐y‐old children were randomly assigned to one of four feeding groups: (1) low‐fat milk (LF) (1.0 g cow's milk fat/dL); (2) standard‐fat milk (SF) (3.5 g cow's milk fat/dL); (3) partially vegetable fat milk (PVF) (3.5 g fat/dL; 50% vegetable fat from rapeseed oil, 50% milk fat); and (4) full vegetable fat milk (FVF) (3.5 g fat/dL; 100% vegetable fat from palm‐, coconut‐ and soybean oil). We found higher amounts of plasma LA in the FVF group than in the LF and SF groups (p < 0.001) and higher amounts of ALA in the PVF group than in the SF (p < 0.001 in TGs, p < 0.05 in CEs) and LF (p < 0.01 in PLs and CEs, p < 0.05 in TGs) groups. However, amounts of plasma arachidonic acid (AA) were similar between groups as well as the amounts of docosahexaenoic acid (DHA) in CEs and PLs. Total trans FAs were lower in CEs in the PVF and FVF groups than in the SF group (p < 0.05 SF vs PVF; p < 0.01 SF vs FVF). Plasma concentrations of α‐tocopherol were higher in the FVF group than in the other groups (p < 0.05 FVF vs SF, p < 0.01 FVF vs SF and PVF).

Conclusion: Children consuming milk diets containing high amounts of vegetable fat present with higher plasma LA and ALA without any effects on amounts of plasma LC‐PUFA. The plasma LC‐PUFA status is not adversely affected by a low‐fat milk diet. AHA and DHA in plasma are not affected by the diets studied, presumably because 15‐mo‐old children may be able to compensate for dietary influences through endogenous LC‐PUFA metabolism.
Tissue transglutaminase autoantibodies and human leucocyte antigen in Down's syndrome patients with coeliac disease
Authors: Agardh D , Nilsson A , Carlsson A , Kockum I , Lernmark Å , Ivarsson S‐A
Published: August 2010

The association between autoantibodies against tissue transglutaminase (tTG) and human leucocyte antigen (HLA)‐DQB1 alleles was tested in Down's syndrome (DS) patients with and without coeliac disease (CD). Immunoglobulin A (IgA) and G (IgG) anti‐tTG were measured in radioligand binding assays and compared with conventionally analysed IgA antibodies against gliadin (AGA) and IgA autoantibodies against endomysium (EMA) in 48 DS patients. HLA‐DQB1 typing was carried out by polymerase chain reaction and hybridization with allele‐specific probes in 41/48 patients. Both IgA‐tTG and IgG‐tTG, as well as EMA, were detected in 7/48 and AGA in 15/48 patients. Intestinal biopsy showed histopathological changes consistent with CD in 9/16 patients. HLA‐DQB1 typing, available for 8/9 patients with and for 33/39 without CD, demonstrated that 5/8 with CD had DQB1*02 compared with 7/33 of those without (p= 0.0345). In patients with anti‐tTG, 5/6 had the DQB1*02 allele compared with 7/35 of those without (p= 0.0053).

Conclusions: Anti‐tTG are HLA‐DQB1*02‐associated autoantibodies which together could be useful screening tests for silent CD in DS patients. In patients with gastrointestinal symptoms or clinical signs of malabsorption, anti‐tTG should be combined with AGA to detect other forms of enteropathies and CD.
Visceral childhood leishmaniasis in Turkey
Authors: Totan M , Dagdemir A , Muslu A , Albayrak D
Published: August 2010

Between 1981 and 2001, we retrospectively analysed 40 cases of visceral leishmaniasis (VL) admitted to the Paediatric Infection Unit of Ondokuz Mayis University Hospital, in the middle Black Sea region of Turkey. Median age at presentation was 3 y. Fever and splenomegaly were found in all patients. Bone marrow smear examination resulted in the diagnosis of VL in 95% of cases. All patients were treated initially with meglumine antimonate and 95% of them were cured with this therapy. The remaining patients were cured with liposomal amphotericin B.

Conclusions: VL should be considered in patients with fever and splenomegaly, particularly those residing in the Mediterranean region. Meglumine antimonate seems to be the first choice of treatment in childhood.
Cardiopulmonary exercise parameters in children with atrial septal defect and increased pulmonary blood flow: short‐term effects of defect closure
Authors: Pfammatter J‐P , Zanolari M , Schibler A
Published: August 2010

Markedly increased pulmonary blood flow because of a relevant atrial septal defect (ASD) leads to impaired cardiopulmonary function during maximum exercise in adults. No comparative preoperative and postoperative data are available on the short‐term effects of shunt closure on cardiorespiratory function at peak exercise in children. Pulmonary function testing at rest and cardiopulmonary exercise testing together with haemodynamic assessment was done prospectively in children with an ASD preoperatively and again after full recovery at 3–4 mo postoperatively and compared with a matched normal population. Sixteen children, aged 6.8–16.1 y, with a defect of 8–23 mm (median 15 mm) and a pulmonary/systemic flow ratio of 1.5–3.5 (median 2.2) were tested and compared with 15 healthy children. Preoperatively, baseline pulmonary function parameters and exercise capacity were no different from normals. At peak exercise, patients with a shunt had increased pulmonary resistance, especially of the distal airways (p= 0.04), with a significantly larger proportion of children having a paradoxical increase in total airway resistance during exercise (p < 0.05). Maximum serum lactate at peak exercise was elevated (p < 0.05) in patients. In patients, maximum oxygen uptake was impaired (p= 0.03) and remained so at repeat evaluation postoperatively. The same observation was made for chronotropic response to exercise.

Conclusion: Cardiopulmonary exercise parameters in patients with ASD differed only slightly from those in normal children. The most important deviations were a lower maximum oxygen uptake and an increase in airway resistance at maximum exercise.
Genetic and clinical features of false‐negative infants in a neonatal screening programme for cystic fibrosis
Authors: Padoan R , Genoni S , Moretti E , Seia M , Giunta A , Corbetta C
Published: August 2010

A study was performed on the delayed diagnosis of cystic fibrosis (CF) in infants who had false‐negative results in a neonatal screening programme. The genetic and clinical features of false‐negative infants in this screening programme were assessed together with the efficiency of the screening procedure in the Lombardia region. In total, 774 687 newborns were screened using a two‐step immunoreactive trypsinogen (IRT) (in the years 1990–1992), IRT/IRT + delF508 (1993–1998) or IRT/IRT + polymerase chain reaction (PCR) and oligonucleotide ligation assay (OLA) protocol (1998–1999). Out of 196 CF children born in the 10y period 15 were false negative on screening (7.6%) and molecular analysis showed a high variability in the genotypes. The cystic fibrosis transmembrane regulator (CFTR) gene mutations identified were delF508, D1152H, R1066C, R334W, G542X, N1303K, F1052V, A120T, 3849 + 10kbC → T, 2789 + 5G → A, 5T‐12TG and the novel mutation D110E. In three patients no mutation was identified after denaturing gradient gel electrophoresis of the majority of CFTR gene exons.

Conclusion: The clinical phenotypes of CF children diagnosed by their symptoms at different ages were very mild. None of them presented with a severe lung disease. The majority of them did not seem to have been damaged by the delayed diagnosis. The combination of IRT assay plus genotype analysis (1998‐1999) appears to be a more reliable method of detecting CF than IRT measurement alone or combined with only the delF508 mutation.
Inflammatory bowel disease in mother or father and neonatal outcome
Authors: Ludvigsson JF , Ludvigsson J
Published: August 2010

Even a minor decrease in birthweight predisposes to adult disease. Inflammatory bowel disease (IBD) in the mother is a risk factor for low birthweight and preterm infants. This study investigated the effect of IBD in the mother or father, adjusting for confounders, on the newborn infant, with the focus on birthweight and pregnancy duration. A total of 10 399 single‐birth mother‐infant pairs was prospectively enrolled within the ABIS project (All Babies In Southeast Sweden). Outcome measures included birth week, preterm birth (<37 wk), birthweight, low birthweight (<2500 g), birth length, caesarean section and neonatal hospital care. Ulcerative colitis (UC) in the mother was associated with lower birthweight in the infant (adjusted difference:—330 g, adjusted 95% confidence interval:—509 to—150 g, p < 0.001), and with even lower birthweight when the mother was treated with Mesalazine or steroids. No decrease in birthweight was seen in infants whose mother suffered from Crohn's disease (CD) (adjusted difference:—65 g, adjusted 95% confidence interval:—354 to 224 g, p > 0.05). Maternal UC or CD did not affect the pregnancy duration. The neonatal outcome of infants whose father suffered from UC and CD did not differ from the control group.

Conclusion: UC in the mother affects the birthweight of the infant, which may predispose to future disease in the infant. Most women and men with UC and CD can, however, expect a healthy child with neither preterm birth nor low birthweight.
Determinants of correct inhalation technique in children attending a hospital‐based asthma clinic
Authors: Kamps AWA , Brand PLP , Roorda RJ
Published: August 2010

Many children with asthma use their inhaler device incorrectly even after comprehensive inhalation instruction. The aim of this study was to identify factors associated with correct inhalation technique. Two hundred children with asthma demonstrated their inhalation technique. Patient characteristics and the components of inhalation instructions they had received were compared for children demonstrating a correct or incorrect inhalation technique. In addition, the inhalation technique of 47 newly referred patients was followed‐up prospectively after repeated comprehensive instruction sessions. Seventy‐eight percent of all patients demonstrated a correct inhalation technique. Patients who had received repeated instruction sessions and patients who had previously been asked to demonstrate the use of their inhaler during an instruction session were more likely than other children to demonstrate a correct inhalation technique (p < 0.001 and p= 0.03, respectively). Multiple logistic regression analysis showed that repetition of instructions was significantly associated with a correct inhalation technique (odds ratio (OR) 8.2, 95% CI 3.2–21.5; p < 0.0001) irrespective of type of inhaler used. Demonstration of the inhaler use by the patient was significantly associated with a correct inhalation technique for patients using a metered dose inhaler plus spacer device (OR 3.5,95% CI 1.0–12.6; p= 0.05), but not for patients using a dry powder inhaler (OR 1.6,95% CI 0.4‐6.4; p= 0.54). The number of newly referred patients demonstrating a correct inhalation technique improved from 57.4% to 97.9% after three comprehensive instruction sessions.

Conclusion: Inhalation instruction should be given repeatedly to achieve and maintain correct inhalation technique in asthmatic children.
Metabolic effects in neonates receiving intravenous medium‐chain triglycerides
Authors: Angsten G , Boberg M , Cederblad G , Meurling S , Stiernström H
Published: August 2010

The effects of two lipid emulsions, one with 50% each of medium‐chain and long‐chain triglycerides, and a long‐chain triglycerides lipid emulsion as a control, were evaluated for lipid and carnitine metabolism and respiratory quotient when given to neonates after major surgery during a short period of total parenteral nutrition. Each group included 10 neonates, and all tolerated the total parenteral nutrition well. The relative contents of linoleic acid and α‐linolenic acid increased in all lipid esters in plasma and adipose tissue in both groups, indicating that the content of these fatty acids is sufficient even in the medium‐chain triglycerides emulsion. The serum concentration of ketones was within normal limits. Free fatty acids in plasma did not increase in either group. The total plasma carnitine concentration decreased in both groups but the distribution of free carnitine and acylcarnitine did not change. The total muscle carnitine did not change significantly but the ratio of acylcarnitine to free carnitine tended to increase in muscle in the treatment group, probably an effect of the medium‐chain triglyceride supplementation.

Conclusions: The two groups displayed the same fatty acid pattern in plasma and adipose tissue and the same respiratory quotient during the treatment period. Regarding carnitine status, essentially the same changes were seen in the two groups. However, discrete changes were seen in muscle tissue in the treatment group.
Effect of BCG vaccine on tuberculin skin tests in 1‐6‐year‐old children
Authors: Bozaykut A , Ipek I Ozahi , Ozkars MY , Seren L Pulat , Atay E , Atay Z
Published: August 2010

Bacillus Calmette Guerin (BCG) vaccination used in the prevention of tuberculosis may cause problems in interpreting the tuberculin skin test (TST), which is commonly used in the diagnosis of infection. A limited number of studies have been undertaken to investigate how length of time after BCG vaccination affects TST results. TST induration values of unvaccinated children were compared with those of children vaccinated once in order to determine the changes in TST responses after BCG vaccination. Mantoux TSTs were administered to 1145 children aged 1–6 y and induration was measured at 72 h. BCG scar status and average TST induration diameters were identified for each age group.

Conclusion: Average TST induration in vaccinated children is significantly higher than that in unvaccinated children, and in the vaccinated group there is no statistically significant difference between induration values in the different age groups. BCG vaccination at the age of 0–2 mo affects TST for a long period and this condition does not change until 6 y of age.
Prospects of vaccination as a means of preventing mother‐to‐child transmission of HIV‐I*
Authors: Biberfeld G , Buonaguro F , Lindberg A , de Thé G , Yi Z , Zetterström R
Published: August 2010

Although short‐course antiretroviral therapy is efficient in reducing mother‐to‐child transmission (MTCT) of HIV‐1, it does not prevent transmission during the breastfeeding period. There is therefore an urgent need to test various approaches, including HIV‐1 vaccination, to try to prevent postnatal transmission of HIV‐1 in breastfeeding populations in developing countries.
Does breastfeeding protect against allergic rhinitis during childhood? A meta‐analysis of prospective studies
Authors: Bloch A Mimouni , Mimouni D , Mimouni M , Gdalevich M
Published: August 2010

The effect of breastfeeding on the development of allergic rhinitis and other atopic conditions has been assessed in many studies but remains controversial. To elucidate this issue, a systematic review was conducted of prospective studies that evaluated the association between exclusive breastfeeding during the first 3 mo after birth and allergic rhinitis. The 1966‐2000 MEDLINE databases were searched and the reference lists of relevant articles were reviewed according to predetermined inclusion criteria. The methodological aspects of each study, duration and exclusivity of breastfeeding, outcome measures, control for potential confounding variables and other factors were assessed, and estimates of the association between breastfeeding and allergic rhinitis were abstracted independently by the investigators using a standardized approach. Six prospective studies met the inclusion criteria. The summary odds ratio for the protective effect of breastfeeding was 0.74 (95% confidence interval 0.54‐1.01). The effect estimate in studies of children with a family history of atopy was 0.87 (95% confidence interval 0.48–1.58).

Conclusion: Exclusive breastfeeding during the first 3 mo after birth protects against allergic rhinitis in children, both with and without a family history of atopy. The protective association, although of borderline statistical significance, was substantial. Larger prospective studies with strict methodology and longer periods of follow‐up are needed.