bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain lesions in preterms: origin, consequences and compensation
Authors: Krägeloh‐Mann I , Toft P , Lunding J , Andresen J , Pryds O , Lou HC
Published: August 2010

Twenty‐nine high‐risk preterm born children, from a cohort with cerebral blood flow (CBF) measurements in the first 2 d of life, were examined prospectively at the age of 5.5—7 y neurologically, neuropsychologically and by magnetic resonance imaging (MRI). They were compared to 57 control children in terms of neurology and neuropsychology. Abnormal MRI was found in 19 children. Low oxygen delivery to the brain was found in 63% of them, in contrast to 12.5% in those with normal MRI, indicating neonatal hypoxia‐ischemia as an important factor. The MRI abnormalities were mainly periventricular lesions (n = 19), especially periventricular leucomalacia (PVL, n = 17). Three of the very preterm children had severe cerebellar atrophy in addition to relatively mild periventricular abnormalities. MRI showed specific morphological correlates for the major disabilities, e.g. spastic CP (involvement of motor tracts), mental retardation (bilateral extensive white matter reduction or cerebellar atrophy) and severe visual impairment (severe optic radiation involvement). A morphological correlate for minor disabilities, i.e. functional variations in motor performance or intelligence, was not found, with the exception that symptoms of attention deficit hyperactivity disorder were related to mild MRI abnormalities. This could mean that with respect to cognitive functions, mild or unilateral periventricular MRI lesions could be compensated. However, as among preterms without mental retardation (n = 19), IQ was generally and significantly lower than in the control group; other, more chronic pathogenetic factors, not detectable by MRI alone, may play a role. □Attention deficit hyperactivity disorder, cerebral blood flow, cerebral palsy, magnetic resonance imaging, oxygen delivery, periventricular leucomalacia, prematurity
Serum cholesterol ester fatty acids in 7‐ and 13‐month‐old children in a prospective randomized trial of a low‐saturated fat, low‐cholesterol diet: the STRIP baby project
Authors: Salo P , Viikari J , Hämäläinen M , Lapinleimu H , Routi T , Rönnemaa T , Seppänen R , Jokinen E , Välimäki I , Simell O
Published: August 2010

To evaluate changes that occur in serum cholesterol ester fatty acid composition during the transition from typical infant feeding to a more adult type of nutrition, this study compared the effects on serum cholesterol ester fatty acids of breast milk or formula at the age of 7 mo with effects caused by 6‐mo dietary intervention in 137 children. The intervention [Special Turku coronary Risk factor Intervention Project for children (STRIP baby project)] aimed at a reduction of saturated fat intake to 10% of energy after the age of 1 y without purposefully influencing total fat intake. Nutrient intakes were calculated from 3‐d food records. At the age of 7 mo, i.e. before dietary education began, milk type markedly influenced dietary and serum cholesterol ester fatty acid composition (mean serum cholesterol ester 16:0 in breastfed vs formula‐fed infants, 13.7% vs 12.0%, respectively, p < 0.001; serum cholesterol ester 18:2n‐6 50.6% vs 57.6%, p < 0.001). At the age of 13 mo the calculated fat intake of the intervention and control children differed markedly but serum cholesterol ester fatty acid compositions in all children resembled closely those measured in 7‐mo‐old breastfed infants, e.g. at the age of 13 mo the relative proportions of 18:2n‐6 were 49.9% and 51.1% in previously formula‐fed intervention and control children, respectively, and 50.3% and 50.1% in previously breastfed intervention and control children, respectively. In conclusion, serum cholesterol ester fatty acid composition reflected differences in dietary fat quality (breast milk or formula) at the age of 7 mo, whereas dietary intervention as applied in the STRIP baby project had only a minimal effect. □Cholesterol esters, dietary intervention, fatty acids, infant feeding
Increased urinary nitric oxide oxidation products in children with active coeliac disease
Authors: van Straaten EA , Koster‐Kamphuis L , Bovee‐Oudenhoven IM , van der Meer R , Forget P‐Ph
Published: August 2010

Background:Nitric oxide (NO) production catalyzed by iNOS (inducible NO synthase) is thought to take place mainly in macrophages after activation by inflammatory mediators. NO is subsequently oxidized to nitrite and nitrate, which are excreted in urine. The concentration of inflammatory mediators in small bowel biopsy specimens from patients with coeliac disease is increased. The latter could induce increased NO production by stimulation of intestinal macrophage iNOS, resulting in high levels of urinary NO oxidation products, nitrite and nitrate (NOx).Aim:In the present study we evaluated the urinary NOx/creatinine ratios in children with active coeliac disease (n =22), coeliac disease patients on a gluten‐free diet(n =9), healthy (n=11) and sick control children(n =18).Methods:The Griess reagent method was used for measuring urinary NOx.Results:Median NOx/creatinine ratios of active coeliac disease patients, coeliac disease patients on a gluten‐free diet, healthy and sick control patients were 1.21, 0.19, 0.10 and 0.13 mmol/mmol, respectively. All active coeliac disease patients showed increased NOx/ creatinine ratios. Urinary NOx/creatinine ratios of the active coeliac disease patients were significantly higher than those of healthy controls(p< 0.0001), sick controls(p< 0.0001) and coeliac disease patients on a gluten‐free diet(p< 0.0001).Conclusion:The urinary NOx/creatinine ratio is increased in patients with active coeliac disease and reverts to normal on a gluten‐free diet. □Coeliac disease, nitric oxide, urinary nitrate
Prevalence of coeliac disease in Turner syndrome
Authors: Ivarsson S‐A , Carlsson A , Bredberg A , Alm J , Aronsson S , Gustafsson J , Hagenäs L , Häger A , Kriström B , Marcus C , Moëll C , Nilsson KO , Tuvemo T , Westphal O , Albertsson‐Wikland K , Aman J
Published: August 2010

This study was undertaken to investigate the prevalence of coeliac disease in children and adolescents with Turner syndrome. Eighty‐seven children and adolescents with Turner syndrome were screened for IgA‐antiendomysium antibodies (EMA) and IgA‐antigliadin antibodies (AGA), 5% (4/87) being found to be EMA‐positive, and 15% (13/87) to have AGA levels above normal. Of the 10 patients who were either AGA‐ or EMA‐positive and further investigated with intestinal biopsy, four manifested villous atrophy (i.e. all three of the EMA‐positive patients, but only one of the seven AGA‐positive patients). The results suggest EMA‐positivity to be a good immunological marker for use in screening for coeliac disease, and such screening to be justified in patients with Turner syndrome. □Coeliac disease, IgA‐antiendomysium antibodies, IgA‐antigliadin antibodies, Turner syndrome
Mitochondrial DNA point mutations detected in four cases of sudden infant death syndrome
Authors: Opdal SH , Rognum TO , Torgersen H , Vege Å
Published: August 2010

The aim of this study was to investigate the tRNALeu (UUR) gene and the first part of the ND1 gene in mitochondrial DNA (mtDNA) in cases of sudden infant death syndrome (SIDS). A total of 158 cases of SIDS and 97 controls were included in the study, and the base pairs in the range 3230—3330 were investigated using polymerase chain reaction (PCR) and temporal temperature gradient electrophoresis (TTGE). If a band shift was detected by TTGE, the area investigated and the D‐loop was sequenced. Three different point mutations (T3290C, T3308C and T3308G) were detected in four of the SIDS cases, while none of the controls were mutated. We also found a high D‐loop substitution rate in these four cases. The findings indicate that mtDNA mutations may play a role in some cases of SIDS. □Mitochondrial DNA, ND1, sudden infant death syndrome, tRNALeu(UUR)
Comparison of lignocaine‐prilocaine cream and amethocaine gel for local analgesia before venepuncture in children
Authors: Choy L , Collier J , Watson AR
Published: August 2010

The efficacy of lignocaine‐prilocaine cream (EMLA™) and amethocaine gel (Ametop™) in reducing the pain and distress of venepuncture was compared in a single‐blind randomized study of 34 children aged 1—14 y. The influences of age, anxiety and past experience were also investigated. Pain was assessed by the researcher using the Observation Scale of Behavioural Distress, and by the parent, doctor and child (if old enough) using a 10‐cm, 100‐point Visual Analogue Scale (VAS). Doctors also completed a simple rating scale for difficulty of venepuncture. Compared to older children, infants had significantly more anxious parents and were more distressed when being held still. Anticipatory anxiety correlated with higher pain ratings. No differences in the analgesic effect of the two preparations were found. We conclude that whilst EMLA and Ametop are equally effective at reducing the pain of needle puncture, under some circumstances the use of Ametop may be more advantageous. □Children, local anaesthetic, needle pain, venepuncture
Speech and language skills in children who required neonatal intensive care: evaluation at 6.5 y of age based on interviews with parents
Authors: Jennische M , Sedin G
Published: August 2010

Speech and language skills at 6.5 y of age were studied in a follow‐up of a cohort of children who had required neonatal intensive care (NIC) at Uppsala University Children's Hospital. An interview with the parents indicated that preterm and full‐term NIC children were older than control children when they reached certain stages in language development (short sentences, intelligible speech). Absence of babbling was more common in NIC children born at 23—27 wk than in other preterm NIC children, and occurrence of stuttering was more commonly noticed in preterm NIC children born at 23—27 wk than in those born at ≥32 wk and controls. □Babbling, infants, language, neonatal intensive care, preterm, stuttering
Do adolescents’own intentions regarding healthy behaviours affect outcome? A two‐year prospective study
Authors: Berg‐Kelly K , Kullander K
Published: August 2010

Adolescents’own intentions regarding health behaviours, in addition to their context, are believed to be important for the health habits they chose. This was studied prospectively over a 2‐y period. A total of 552 students, 391 aged 13 y and 161 aged 15 y, reported their health and problem behaviours, socioeconomic background and intentions regarding health behaviours through questionnaires in 1991 and in 1993. Outcome dealt with three domains: health habits; acquisition of adult lifestyles; and problem behaviours. The material was analysed for correlations. Significant results were entered into multiple regression stepwise procedures. As expected, already having initiated adult lifestyles or problem behaviours were the most important factors associated with such behaviours 2 y later. Further analyses were then limited to those students who had not started such lifestyles, in order to determine what factors kept them from doing so in a 2‐y span. Key predictors for healthy behaviours were adolescents’own decisions not to engage in adult lifestyles or risky behaviours, family processes consistent with support and school satisfaction. Association with peer groups where smoking and drinking were commonplace predicted less optimal behaviours. Gender or socioeconomic factors were not predictive. The results support a comprehensive approach to health promotion during adolescence. □Adolescence, alcohol, health promotion, parenthood
Prone position in spontaneously breathing infants with pneumonia
Authors: Chaisupamongkollarp T , Preutthipan A , Vaicheeta S , Chantarojanasiri T , Kongvivekkajornkij W , Suwanjutha S
Published: August 2010

This study was designed to evaluate further the effect of prone positioning on oxygen saturation (SpO2) and respiratory mechanics in spontaneously breathing infants with pneumonia. SpO2 and respiratory mechanics were measured in the supine and prone positions in 17 infants. Prone positioning resulted in statistically significant increases in mean (± SD) SpO2 (95.52 ± 2.87 to 98.00 ± 2.40%, p= 0.0002) and respiratory system compliance (5.99 ± 2.52 to 7.93 ± 4.30 ml/ cmH2O, p= 0.02). This suggests that prone positioning is another beneficial supportive measure for spontaneously breathing infants with pneumonia. □Mechanics, oxygen, pneumonia, prone
Changes in growth and metabolism in very low birthweight infants fed with fortified breast milk
Authors: Nicholl RM , Gamsu HR
Published: August 2010

Human milk is often inadequate nutritionally for preterm infants. We investigated the effect of adding a commercially prepared milk fortifier to human (maternal or bank) milk and measured changes in lower leg length velocity (LLLvel) using knemometry, weight gain and biochemical indices of nutrition. Babies were allocated to one of three feed groups, in a semi‐randomized fashion, to receive human milk alone (group I), fortified human milk (group II) or a preterm formula (group III). The birthweights (median and R) and birth gestations (median and R) of the three groups were as follows: group I 1099 g (654‐1248 g) and 28 wk (26‐32 wk); group II 838 g (742‐1340 g) and 31 wk (28‐36); group III 1136g (624‐1552 g) and 32 wk (27–36 wk). All babies who received fortified milk either showed significant (p = 0. 0004) acceleration in LLLvel during the period studied, or maintained their pre‐study period velocity. This increase in LLLvel was comparable to that achieved by a group of babies given a standard preterm infant formula (p<0.001). By comparison, the control group's change in LLLvel was more modest (p= 0.04). Babies who received human milk with the fortifier added had the lowest serum levels of alkaline phosphatase at the end of the study period when compared to the other two groups. Other biochemical indices were similar in the three feed groups. No adverse clinical events were encountered which could be attributed to the use of the breast milk fortifier.
Decreased activity of plasma cholesteryl ester transfer protein in children and adolescents with insulin‐dependent diabetes mellitus
Authors: Hayashibe H , Asayama K , Nakane T , Kobayashi K , Amemiya S , Nakazawa S
Published: August 2010

The aims of the present study were to determine whether the activity of cholesteryl ester transfer protein (CETP) is altered in the plasma of children and adolescents with insulin‐dependent diabetes mellitus (IDDM), and whether high‐density lipoprotein‐cholesterol (HDL‐C) levels reflect CETP activity. Plasma CETP activity was measured by a micromethod for radioisotopic assay, using exogenous lipoproteins as donor and acceptors. The study subjects were 22 Japanese children and adolescents with IDDM (8M, 14F) with a mean age of 13.0 y. They were non‐obese and did not suffer from any significant nephropathy. The age‐matched control group consisted of 20 children (10M, 10F) with a mean age of 12.7 y. Serum triglycerides were significantly decreased, while the levels of HDL‐C and apolipoprotein (apo) A1 were markedly increased, in the IDDM patients. Plasma CETP activity was significantly lower in the IDDM patients than in the control children. None of the anthropometric indices nor the biochemical data correlated significantly with CETP activity in the IDDM patients. Suppression of CETP along with the putative activation of lipoprotein lipase due to peripheral hyperinsulinism appears to induce synergistically the increase in HDL‐C in IDDM children.
Cardiac involvement in Sydenham's chorea: clinical and Doppler echocardiographic findings
Authors: Elevli M , Çelebi A , Tombul T , Gökalp A Sevim
Published: August 2010

Sydenham's chorea is often encountered in pure form, but it may also occur in association with carditis. Recently, it has been reported that silent, mild valvular regurgitation has been encountered in patients with rheumatic fever manifested by isolated polyarthritis and pure chorea. We studied 22 children with Sydenham's chorea to determine clinical and subclinical heart involvement at the time of the initial diagnosis. Ages of the patients ranged from 6–19 y (mean 13.14 ± 3.0), and the female/male ratio was 3.4:1. All patients were evaluated by clinical and echocardiographic examination with respect to heart involvement. Carditis was detected in only 5 of 22 patients (23%) by auscultation. Clinical valvular involvement was determined: mitral regurgitation in three and combined mitral and aortic regurgitation in two. The frequency of valvular involvement increased significantly to 63% (14/22) after adding silent mitral regurgitation detected by colour Doppler echocardiography (χ2= 7.50, p= 0.0062). We found that clinically inaudible, but echocardiographically significant, mild valvular regurgitation was frequent in patients with pure chorea. It is concluded that colour Doppler echocardiography may be useful in detecting silent valvular regurgitation and in deciding the duration of prophylaxis.
Widespread pain and neck pain in schoolchildren. A prospective one‐year follow‐up study
Authors: Mikkelsson M , Sourander A , Salminen JJ , Kautiainen H , Piha J
Published: August 2010

The aims of this study were to prospectively follow up population‐based cohorts of children with widespread pain, children with neck pain and pain‐free children, in order to evaluate 1‐y changes in pain symptoms and to evaluate predictors for persistent widespread pain and for the change of neck pain to widespread pain. A structured pain questionnaire, the Children's Depression Inventory, and a sleep questionnaire were completed by the pre‐adolescent cohorts, and clinical evaluation with tender point palpation and pain threshold measurements was carried out in both years. The Child Behavior Checklist, the Teacher's Report Form and a sociodemographic questionnaire were completed at baseline. More children in the 2 pain cohorts reported pain at follow‐up than did controls (p<0.0001). Children with persistent widespread pain had lower pain thresholds compared with those whose pain classification changed. In the neck pain group, 19 (20.4%) reported widespread pain at follow‐up. Although depressive symptoms and sleep problems were associated with the change of neck pain to widespread pain, neither they nor other measured factors showed independent explanatory power in multiple logistic regression analysis. In conclusion, fluctuation of pain symptoms occurred mainly among pain cohorts. Depressive and sleep problems may have an effect on the spreading of regional neck pain to widespread pain. Pain threshold measurement and evaluation of depressive and sleep problems may be useful tools for secondary prevention of musculoskeletal pain in pre‐adolescents.
Mid‐term follow‐up after multiple system organ failure following cardiac surgery in children
Authors: Heying R , Seghaye M‐C , Grabitz RG , Kotlarek F , Messmer BJ , von Bemuth G
Published: August 2010

Multiple system organ failure after cardiac surgery in children is a severe complication with unknown mid‐ and long‐term sequelae. We therefore evaluated 11 children (aged 20‐126 mo, median: 67 mo) having survived multiple system organ failure after cardiac operations for congenital cardiac defects in a cross‐sectional follow‐up study 12–76 mo (median: 32 mo) after surgery. Clinical and laboratory examinations included cardiac, pulmonary, renal, hepatic, neurological and psychological function tests. All patients had adequate cardiac function. Lung mechanics were abnormal in three children and glomerular renal function was abnormal in two patients. Slight elevation of γ‐glutamyl transpeptidase and coagulation factor deficiency was present in six and seven patients, respectively (five of whom had undergone the Fontan operation). Severe neurological sequelae such as diplegia (n = 1) and mental retardation (n = 1) were observed in two patients. In addition, five children presented delayed motor, graphomotor and/or speech development. Two children were found to have abnormal intelligence. We conclude that with the exception of neurological impairment, mid‐term sequelae of multiple system organ failure after cardiac surgery in children are mild. However, longer follow‐up using an appropriate control group is mandatory.
Persistent value of air‐augmented radiograph in neonatal high gastrointestinal obstruction, despite more modern techniques
Authors: Harrison RL , Set P , Brain AJL
Published: August 2010

Air is a safe and effective natural contrast agent in neonatal high gastrointestinal (GIT) obstruction. Successful early decompression often results in plain abdominal radiographs of low diagnostic yield. We present a series of neonates with high GIT obstruction in whom air‐augmented abdominal radiographs (AAAR) were performed instead. Fourteen neonates presented with suspected high GIT obstruction. In 12 sick babies, obstruction was confirmed and the level of obstruction was determined. The other two neonates required additional positive contrast upper GIT studies. These confirmed small bowel malrotation. For neonatal high GIT obstruction an AAAR can provide a rapid and accurate diagnosis. Positive contrast agent studies should be performed when the AAAR is non‐diagnostic.
Pain management in neonates
Authors: Larsson BA
Published: August 2010

Recent research suggests that infants may be more vulnerable to the negative effects of pain than older children and adults. Apart from short‐term effects, untreated pain and stressful stimuli may also have long‐term effects, which may later affect their neurological development, including the reaction to pain. The preterm neonate is at especially high risk. Despite convincing evidence from recent research of the necessity to treat pain and to avoid early exposure to pain, the neonate is still subjected to painful procedures and even surgery without adequate pain treatment. This inadequacy could be due to insecurity regarding the pharmacokinetics and pharmacodynamics of pain‐related drugs, to a limited understanding of the pain behaviour and pain physiology and the lack of appropriate measurement tools. The present paper reviews recent research in relation to management of pain in the newborn and considers implications for practice and future studies.
Duration of breastfeeding and developmental milestones during the latter half of infancy
Authors: Vestergaard M , Obel C , Henriksen TB , Sørensen HT , Skajaa E , Østergaard J
Published: August 2010

Several studies have suggested that breastfeeding has a long‐term influence on brain development. However, interpretation of these findings is complicated by the presence of many potential confounding factors. Only a few studies have examined infants before 1 y of age, although very early assessment might reduce the role of environmental influence. We investigated the association between exclusive breastfeeding and three developmental milestones related to general and fine motor skills and early language development at the age of 8 mo. We followed 1656 healthy, singleton, term infants, with a birthweight of at least 2500 g, born between May 1991 and February 1992 in Aarhus, Denmark. Information was collected at 16 wk gestation, at delivery and when the infant was 8 mo old. Motor skills were evaluated by measurement of crawling and pincer grip. Early language development was defined as the ability to babble in polysyllables. The proportion of infants who mastered the specific milestones increased consistently with increasing duration of breastfeeding. The relative risk for the highest versus the lowest breastfeeding category was 1.3 (95% CI: 1.0‐1.6) for crawling, 1.2 (95% CI: 1.1‐1.3) for pincer grip and 1.5 (95% CI: 1.3–1.8) for polysyllable babbling. Little change was found after adjustment for confounding. In conclusion, our data support the hypothesis that breastfeeding benefits neurodevelopment.
Iron status of children in southern Sweden: effects of cow's milk and follow‐on formula
Authors: Bramhagen A‐C , Axelsson I
Published: August 2010

Aim. The objective of the study was to investigate iron status in children in relation to intake of cow's milk and follow‐on formula. Methods. In all, 367 healthy 2.5‐y‐old children were enrolled in the study. The amounts of cow's milk and formula consumed were recorded. B‐haemoglobin, S‐ferritin, S‐iron, total iron binding capacity and mean corpuscular volume were analysed. Results. Seven percent of the children had iron deficiency anaemia (Hb <110 g/l) and 10% had S‐ferritin <12 μg/1. Furthermore, 10% of the children were iron deficient, with or without anaemia. Children with iron deficiency had a higher intake of cow's milk (382 ml, 95% confidence interval (CI) 294‐496, vs. 257 ml, CI 232–272, p< 0.0001), and fewer consumed follow‐on formula (11% vs. 43%, p = 0.0002) compared to those with sufficient iron. Conclusion. Iron deficiency is still common during childhood in Sweden. Intake of cow's milk is significantly higher in children with iron deficiency. In contrast, iron deficiency is less frequent among those consuming follow‐on formula.
Severe sleep problems among infants in a normal population in Sweden: prevalence, severity and correlates
Authors: Thunström M
Published: August 2010

The aim of this study was to explore the prevalence of parentally experienced infant sleep problems, with special interest in severe problems, in a total community sample of 2518 infants aged 6–18 mo. Correlates to severe sleep problems were sought. The families were approached using a questionnaire and 83% responded. Data from the collection procedure point to a non‐selective dropout. Sixteen percent of the parents reported their children as having moderate or severe difficulties in falling asleep at night (sleep refusal, bedtime struggles) and 30% reported frequent night waking. Almost all (93%) of the parents had sought help at the Child Health Centre (CHC), but only 48% were satisfied with the support and advice they got. Severe sleep problems as defined by the ICSD (International Classification of Sleep Disorders, 1990) were found in 129 of the children (6.2%), who were studied in detail, with the rest of the population as controls. Severe sleep problems were found to be correlated with parental worries and anxiety concerning infant health (although the children were reported as being as healthy as the controls), infant feeding problems and intensive parental interventional behaviour (especially feeding) during the evening and night. A common factor of insecurity in the parental role is suggested.
Transmission of primary nocturnal enuresis and attention deficit hyperactivity disorder
Authors: Bailey JN , Ornitz EM , Gehricke JG , Gabikian P , Russell AT , Smalley SL
Published: August 2010

Primary nocturnal enuresis (PNE) is a prevalent disorder among children with a complex mode of inheritance. Family, twin, and linkage studies have provided evidence that genetic factors underlie the familiarity of PNE. Linkage investigations support the hypothesis that PNE is heterogeneous, and the genetic heterogeneity may be reflected in co‐morbid clinical conditions such as attention deficit hyperactivity disorder (ADHD). This study used a family study method and examined the transmission of PNE in relatives of PNE and control probands with and without ADHD, to determine if these disorders co‐occur due to common genetic susceptibilities or other, i.e. non‐genetic, reasons. This study concluded that the pattern of inheritance found is consistent with the independent transmission of PNE and ADHD.
Prevalence of nocturnal enuresis and accompanying factors in children aged 7–11 years in Turkey
Authors: Gürnüš B , Vurgun N , Lekili M , Işcan A , Müezzinoǧlu T , Büyüksu C
Published: August 2010

There has been limited epidemiological research about nocturnal enuresis in Turkey. The objectives of this study were to ascertain the prevalence of nocturnal enuresis and the epidemiological factors associated with this in Turkish children aged 7–11 y, living in Manisa. Included in the study were 2000 children from various primary schools in Manisa. Parents were asked to fill out our specially designed questionnaire. In all, questionnaires for 1703 children were completed and returned to the department (871F, 51.1%; 832M, 48.9%). The prevalence of nocturnal enuresis for females was 10.6%, for males it was 16.9% and the overall prevalence was 13.7%. The prevalence of nocturnal enuresis decreased with age. Enuresis nocturna was found to be more common in children with a family history of bedwetting (76.5%). Deep sleeping, poor toilet habits and low educational level of the family were associated with enuresis. Consanguineous marriage did not influence the incidence of enuresis nocturna. There was no difference between enuretics and non‐enuretics with reference to breastfeeding, being firstborn or being right‐ or left‐handed. In our opinion, enuresis is an important problem for both families and children in Turkey for which specific guidelines should be developed. Various methods have been tried in the treatment of enuresis because of its multi‐factorial aetiology. Child, family and physician co‐operating together achieve the best help to both child and family.
Asthma and respiratory infections in school children with special reference to moisture and mold problems in the school
Authors: Taskinen T , Hyvärinen A , Meklin T , Husman T , Nevalainen A , Korppi M
Published: August 2010

Aim of the study: Initially, we performed a questionnaire study on 622 school children aged 7 to 13 y. The study was supplemented with a clinical study including skin prick tests to 13 molds in 212 (34%) children with doctor‐diagnosed asthma or parental‐reported wheezing or prolonged cough. These children were attending one of two elementary schools, one with moisture problems (index) school, the other being the control school. The objective of the study was to evaluate whether exposure to moisture and sensitization to molds are associated with respiratory manifestations in school children. Results: The prevalence of asthma was 4.8%, which was similar in the children from both schools. The children from the index school more often had wheezing (16% vs 6%; p< 0.001) and cough (21% vs 9%; p< 0.001) symptoms than control children. Positive skin reactions to molds were rare (2.4%), being present in 7% of asthmatic and in 1–2% of non‐asthmatic children (NS). Lower respiratory tract infections were more common in the spring than in the fall in children from the index school, but not in control children, and the difference between the schools was significant in emergency visits (OR = 2.0, p < 0.01) and antibiotic courses (OR = 2.1, p < 0.01). Conclusions: We found evidence of an association between moisture or mold problems in the school building and the occurrence of respiratory infections, repeated wheezing and prolonged cough in school children.
Minimum time intervals for serial measurements of growth in recumbent length or stature of individual children
Authors: Himes JH
Published: August 2010

A method is presented to estimate minimum time intervals for meaningful measurements of growth in recumbent length or stature on individual children. These intervals are based on the statistical features of growth, and consider the reliability of measurement, expected rates of growth, and variation in attained length or stature. Because of the assumptions used, the intervals should be considered as minima, except in some predictable cases. During the prepubescent period there are no differences in minimum intervals calculated for boys and girls. The intervals are shortest during the rapid growth attending infancy, and increase to 0.39 y (4.7 mo) at 8 y of age in boys and girls, and to 0.43 y (5.2 mo) at 10 y of age in boys. A reference curve of minimum intervals for length and stature during the prepubescent period is presented with an equation for more precise estimation of measurement intervals. To accommodate the pubescent growth spurt and its normal variation in timing, 0.5 y is recommended as the minimum interval during pubescence when the maturational timing of the child is unknown. These minimum measurement intervals should be appropriate for almost all individual children when growth in recumbent length or stature is measured serially.
Composition of long chain polyunsaturated fatty acids in human milk and growth of young infants in rural areas of northern China
Authors: Xiang M , Lei S , Li T , Zetterström R
Published: August 2010

The main source of fat in the diet in rural areas of northern China is soybean oil, therefore the pattern of essential fatty acids in human milk may be assumed to differ from that in milk from women in Western countries and to be similar to that of vegans. The concentrations of long chain polyunsaturated fatty acids in human milk and information on diet were analysed for 41 lactating women in rural areas of north China, and the growth of their infants was measured. The subjects were divided into two groups (group I, 1 mo postpartum; group II, 3 mo postpartum). The dietary intake of the mothers was high in carbohydrate and low in fat, protein and energy. The concentrations of linoleic acid (LA) and α‐linolenic acid (LNA) were high. The ratio of LA to LNA, (21.6), was higher than has been reported from other countries. The concentration of docosa‐hexaenoic acid (DHA) was low and the ratio of arachidonic acid (AA) to DHA was much higher (2.8) than recommended and similar to that found in vegans. The concentrations of AA and DHA in the milk correlated positively with the infants'weight gain at the third month (p < 0.05) and of DHA with length gain at the first and third months (p < 0.01). Since the concentration of AA and, particularly, DHA in the milk declined during lactation, DHA deficiency may appear after 3–4 mo of age in breastfed Chinese rural infants. Further studies of Chinese rural mother‐infant pairs are necessary to prove whether supplementation with suitable sources of AA and DHA, such as fish oil, should be recommended as lactation is lengthened to ensure optimal infant growth and development.
Gender differences in respiratory, nasal and skin symptoms: 6–7 versus 13–14‐year‐old children
Authors: Wieringa MH , Weyler JJ , Van Bever HP , Nelen VJ , Vermeire PA
Published: August 2010

ISAAC questionnaires were completed by the parents of 6432 children, aged 6–7 y and by themselves by 2864 children 13–14‐y‐old. Prevalence rates of respiratory and nasal symptoms and a diagnosis of asthma and hay fever were higher in 6–7‐y‐old boys than in girls, while girls aged 13–14 y had higher rates for most symptoms, except asthma. Underdiagnosis of asthma in 13–14‐y‐old girls cannot be excluded as an explanation, but our data suggest under‐reporting of respiratory and nasal symptoms in 13–14‐y‐old boys.
Killed oral Shigella vaccine made from Shigella flexneri 2a protects against challenge in the rabbit model of shigellosis
Authors: Chakrabarti MK , Bhattacharya J , Bhattacharya MK , Nair GB , Bhattacharya SK , Mahalanabis D
Published: August 2010

The protective efficacy of an orally administered heat‐killed virulent strain of Shigella flexneri 2a (5 weekly oral doses) was evaluated in 25 rabbits (14 immunized and 11 non‐immunized controls) against challenge with the same strain of Shigella using the rabbit model of shigellosis. All 11 non‐immunized rabbits developed bloody diarrhoea following challenge and 6 (54%) died. None of the 14 immunized rabbits developed diarrhoea (all had pellet stools) but 3 (21%) died from causes not associated with diarrhoea. Protection from diarrhoea and dysentery following oral immunization with a killed Shigella species was 100% and highly significant. Death following challenge was 2.5‐fold higher in the non‐immunized group (p= 0.115) but was not significant. These promising results suggest that further studies should be undertaken to develop a killed oral vaccine against shigellosis.
Myocardial function after autologous bone marrow transplantation in children: a prospective long‐term study
Authors: Lönnerholm G , Arvidson J , Andersson L‐G , Carlson K , Jonzon A , Sunnegårdh J
Published: August 2010

Early cardiac complications after autologous bone marrow transplantation (ABMT) were recorded for 49 children with haematological malignancies. There was no procedure‐related mortality and only two cases of early post‐transplant cardiac complications of clinical relevance, both of which were reversible. For 35 long‐time survivors (median follow‐up 7y) serial evaluations before and after ABMT included ECG, chest radiography, echocardiography and equilibrium radionuclide ventriculography (RVG). One patient had frequent supraventricular ectopic beats after ABMT, a finding not previously noted. The mean left ventricular diastolic diameter (LVDD) was 104% of expected before ABMT (95% confidence interval 99–110). During the first year post‐transplant LVDD was about 110% of expected, but thereafter normalization occurred. The mean shortening fraction before ABMT was 31% (CI 29–34), compared with the mean value of 34% for healthy children in our laboratory, and it ranged between 29% and 33% during the follow‐up period. Mean left ventricular ejection fraction determined by RVG was 65% (CI 61–69) and mean right ventricular ejection fraction was 46% (CI 43–49) before ABMT, and they did not change during follow‐up. It is encouraging that these heavily pre‐treated children could be autografted without serious cardiac complications or deterioration in myocardial performance in a 5–10‐y prospect, but longer follow‐up is needed for a final evaluation.
Assessment of terminal ileal and colonic inflammation in Crohn's disease with 99mTc‐WBC
Authors: Charron M , Del Rosario F , Kocoshis S
Published: August 2010

We evaluated the sensitivity and specificity of Technetium‐99m (99mTc)‐white blood cell (WBC) for identifying terminal ileum inflammation in children with Crohn's disease (CD). In 40 children, total colonoscopy was done within a few days of a 99mTc‐WBC scan carried out to evaluate the inflammation in children with CD. In 38 patients the intensity and the location of inflammation shown on the 99mTc‐WBC scan of the colon were similar to the biopsy result of the colonoscopy. The sensitivity of the 99mTc‐WBC scan was 97% in assessing colonic inflammation compared with colonoscopy. The 99mTc‐WBC scan allowed evaluation of inflammation in the terminal ileum in 21 patients in whom the endoscopist did not cannulate the terminal ileum. Of the 19 patients in whom the terminal ileum was visualized endoscopically (14) or surgically (5), the 99mTc‐WBC scan findings showed a similar degree of inflammation in 17. The 99mTc‐WBC scan was abnormal in 10 of these 21 children in whom the gastroenterologist did not reach the terminal ileum. In these children with no ileoscopy the results of the 99mTc‐WBC scan were consistent with the laboratory values, the gastroenterologist's clinical assessment and with long‐term clinical follow‐up. Finally, the 99mTc‐WBC scan of 83 controls did not reveal any false‐positive findings in the terminal ileum (colonoscopy result available in 30 controls). When total colonoscopy or ileoscopy is not performed or when contrast radiography is negative or unable to differentiate CD from lymphoid nodular hyperplasia, scintigraphy can demonstrate the presence of ileitis and/or colitis.
A prospective audit of paediatric colonoscopy under general anaesthesia
Authors: Stringer MD , Pinfield A , Revell L , McClean P , Puntis JWL
Published: August 2010

Colonoscopy in children is frequently performed using intravenous sedation. Traditionally, there have been few advocates of general anaesthesia and some have regarded colonoscopy conducted in this way as potentially more hazardous. The aim of this study was to undertake a prospective audit of paediatric colonoscopy carried out under general anaesthesia. The details of all children referred for colonoscopy during a 3.5‐y period were collected prospectively and the safety and efficacy of performing colonoscopy under general anaesthesia were analysed. A total of 250 colonoscopies was performed in 215 children of median age 10.7 y (range 5 months to 16y) and ileoscopy was carried out in 164 of these cases. An increasing proportion of patients was investigated as day‐cases, including most of the 56 who had additional procedures carried out under the same anaesthetic. There were no complications from the colonoscopy (including the 18 patients who underwent polypectomy). Only one procedure‐related complication occurred and this was avoidable. These results confirm the safety of paediatric colonoscopy under general anaesthesia and demonstrate the advantages and feasibility of such an approach.
Congenital hypothyroidism, seasonality and consanguinity in the West Midlands, England
Authors: Hall SK , Hutchesson ACJ , Kirk JM
Published: August 2010

Seasonal variation in the incidence of congenital hypothyroidism (CHT) is reported by some centres. Also, the incidence of CHT varies with ethnic origin. We report our experience in the West Midlands, England. The overall incidence of CHT among 1128632 neonates screened over 16 years in the West Midlands was 1:2924 live births, but was increased (1:2323; p < 0.05) between October and December. In the city of Birmingham between 1981 and 1991, the incidence of CHT was 1:781, 1:5540 and 1:2257 in Pakistani, Indian and North‐West European children, respectively; no cases were seen in those from other ethnic groups. Consanguinity among those of Pakistani descent could account for the increased incidence within this population. Identification of the cause of seasonal variation may aid development of preventative strategies.
High‐dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice
Authors: Alpay F , Sarici SU , Okutan V , Erdem G , Özcan O , Gökçay E
Published: August 2010

A controlled study was conducted to assess the role of high‐dose i.v. immunoglobulin (HDIVIG) therapy in neonatal immune haemolytic jaundice. Patients with ABO and/or Rh incompatibilities proved by significant hyperbilirubinaemia (<204mmol 1−1), positive direct antiglobulin test and high reticulocyte count (>10%) were randomly assigned to receive either conventional phototherapy alone or phototherapy with high‐dose i.v. immunoglobulin (1 g kg−1, over 4h) as soon as the diagnosis was established. Exchange transfusions were performed if serum bilirubin concentrations exceeded 290 mmol 1−1 and increased by more than 17 mmol 1−1 per h despite both treatment manoeuvres. Eight of 58 patients in the HDIVIG group required exchange transfusions, whereas it became necessary in 22 of 58 patients in the control group (p < 0.001). The durations of phototherapy and hospitalization in terms of hours were significantly shorter in the HDIVIG group (p < 0.05). No side effects of HDIVIG therapy were observed. In conclusion, HDIVIG therapy in newborns with ABO or Rh haemolytic diseases reduces haemolysis, serum bilirubin levels and the need for blood exchange transfusion, a procedure which has potential complications and carries a risk of mortality.
Fucosidosis: immunological studies and chronological neuroradiological changes
Authors: Ismail EAR , Rudwan M , Shafik MH
Published: August 2010

A 3.5‐y‐old boy of Arabic origin had the clinical features of both type 1 and type 2 fucosidosis, consistent with an intermediate form of the disease. The activity of his leucocyte alpha L‐fucosidase was absent. He presented with recurrent sinopulmonary infection and otitis media in addition to paronychia and a periapical dental abscess. Investigation of his systemic immune function did not reveal a significant underlying defect, but subtle abnormalities, particularly of antibody production and secretory IgA, cannot be excluded. The cranial magnetic resonance images showed periventricular and subcortical white matter abnormalities and mild cortical atrophy in addition to globus pallidus changes.
Italian guidelines for antiretroviral therapy in children with human immunodeficiency virus‐type 1 infection
Authors:   Italian Register for HIV Infection in Children
Published: August 2010

Human immunodeficiency virus‐type 1 (HIV‐1) infection and its treatment are peculiar in children. Adherence and compliance must be carefully taken into account before initiating or changing therapy and in the choice of drugs. Even in the absence of paediatric‐specific trial results and notwithstanding drug‐labelling notations, all antiretroviral drugs should be used when indicated. A combined therapy is compulsory. Therapy is highly recommended in category C or category 3 and recommended in category B children. Indications in categories N1, N2, A1 or A2 are limited. A triple association is recommended in category C or category 3 children or in those with a high viral load, when compliance is guaranteed. A step‐down strategy is not advisable. Infants'treatment should be inserted into controlled studies. Therapy should be changed when serious side effects or poor tolerance (choose drugs with a different toxicity and greater tolerance), poor compliance (individualize the motives) or treatment failure (evaluate progression and adherence) occurs.
Seasonal differences in risk factors for sudden infant death syndrome
Authors: Mitchell EA , Clements M , Williams SM , Stewart AW , Cheng A , Ford RPK ,   On behalf of the New Zealand Cot Death Study Group
Published: August 2010

The aim of this study was to explore whether the risk of sudden infant death syndrome (SIDS) associated with prone sleeping position and other risk factors varies with season. The study was a large nation‐wide case‐control study, which compared 485 cases with 1800 controls. Parents of 393 (81.0%) cases and 1591 (88.4%) controls were interviewed. Obstetric records were also examined. Infants dying in winter were older and had lower birthweights than those dying in summer. The increased risk of SIDS associated with prone sleeping position was greater in winter than in summer. In contrast, the increased risk of SIDS associated with excess thermal insulation and bed sharing was less in winter than in summer. Prone sleeping position accounts for about half of the difference between the mortality rate in summer and that in winter. This suggests that some factor related to season modifies the effect of prone sleeping position.
Boys have more health problems in childhood than girls: follow‐up of the 1987 Finnish birth cohort
Authors: Gissler M , Järvelin M‐R , Louhiala P , Hemminki E
Published: August 2010

The purpose of this study was to describe gender differences in children's health until the age of 7 y. The study cohort consisted of all children born in Finland in 1987 (n =60 254), of whom 99.9% were identified in the follow‐up. Childhood health data were received from five national registers (1987‐94), from regional registers of intellectual disabilities (1987‐96) and from education registers in the largest county (1996). Boys had a 20% higher risk for a low 5‐min Apgar score and an 11% higher risk for being preterm. After the perinatal period, boys had a 64% higher cumulative incidence of asthma, a 43% higher cumulative incidence of intellectual disability, a 22% higher incidence of mortality and a higher, but not statistically significant, incidence of epilepsy and vision disorders. No male excess was found for diabetes or hearing disorders. The healthcare‐related indicators showed poorer health for boys, who had a 37% higher mean of hospital days, a 28% higher risk for receiving social benefits due to health problems and a 13% higher risk for long‐term medication. The differences in the socially defined indicators were greatest, and boys had a two‐ to three‐fold risk of having delayed development, postponed school start or attendance in special education programmes. Gender differences in different social classes were similar. Boys' shorter gestational age at birth did not explain the gender differences in childhood health. Some of boys' poorer health seemed to be biologically based, but the social causes of health problems are amenable to change. In particular, the potential of the school system to reduce ill health among boys should be investigated.