bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fatal biphasic brainstem and spinal leptomeningitis with Cryptococcus neoformans in a non‐immunocompromised child
Authors: Ruggieri M , Polizzi A , Vitaliti MC , Magro G , Musumeci S 
Published: August 2010

Ruggieri M, Polizzi A, Vitaliti MC, Magro G, Musumeci S. Fatal biphasic brainstem and spinal leptomeningitis with Cryptococcus neoformans in a non‐immunocompromised child. Acta Pædiatr 1999; 88: 671‐4. Stockholm. ISSN 0803‐5253Cryptococcal meningitis is one of the most common life‐threatening, invasive fungal infections of the central nervous system in patients with defective T‐lymphocyte function. It is, however, unusual in children. We report on a non‐immunocompromised 10‐y‐old boy without evidence of immunological abnormality who developed headache, vomiting, disturbances of consciousness and areflexia. Magnetic resonance imaging of the brain and the spinal cord revealed enlargement of the ventricles and high signal lesions in the leptomeninges at the level of the cerebral peduncles and the cervical and thoracic cord. Cerebrospinal fluid analysis was positive for Cryptococcus neoformans. He was treated with amphotericin B and was symptom‐free within 1 wk. Despite an extended course of therapy his symptoms suddenly relapsed and he succumbed to the medical complications of cardiac and respiratory failure. Central nervous system appearances at postmortem were those of cryptococcal leptomeningitis. □Cryptococcal, children, neurological, pathology, spinal cord
Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant?
Authors: Kukkonen AK , Virtanen M , Järvenpää A‐L , Pokela M‐L , Ikonen S , Fellman V 
Published: August 2010

The efficacy of a natural porcine surfactant and a synthetic surfactant were compared in a randomized trial. In three neonatal intensive care units, 228 neonates with respiratory distress and a ratio of arterial to alveolar partial pressure of oxygen <0.22 were randomly assigned to receive either Curosurf 100mgkg−1 or Exosurf Neonatal 5 ml kg−1. After Curosurf, the fraction of inspired oxygen was lower from 15min (0.45 ± 0.22 vs 0.70 ± 0.22, p = 0.0001) to 6 h (0.48 ± 0.26 vs 0.64 ± 0.23,p= 0.0001) and the mean airway pressure was lower at 1 h (8.3 3.2 mmH2O vs 9.4 ± 3.1 mmH2O β= 0.01). Thereafter the respiratory parameters were similar. The duration of mechanical ventilation (median 6 vs 5 d) and the duration of oxygen supplementation (median 5 vs 4 d) were similar for Curosurf and Exosurf After Curosurf, C‐reactive protein value over 40 mg r1 occurred in 45% (vs 12%; RR 3.62, 95%CI 2.12‐6.17, p = 0.001), leukopenia in 52% (vs 28%; RR 1.85, 95%CI 1.31‐2.61, β= 0.001) and bacteraemia in 11% (vs 4%; RR3.17, 95%CI 1.05‐9.52, p < 0.05).We conclude that when given as rescue therapy Curosurf had no advantage compared with Exosurf in addition to the more effective initial response. Curosurf may increase the risk of infection.
Infants of women with severe early pre‐eclampsia: the effect of absent end‐diastolic umbilical artery Doppler flow velocities on neurodevelopmental outcome
Authors: Kirsten GF , van Zyl JI , van Zijl F , Maritz JS , Odendaal HJ 
Published: August 2010

Umbilical artery Doppler flow velocity waveform studies were performed over a period of 4 y on 242 women with severe pre‐eclampsia before 34 wk gestation. Sixty‐eight (28%) had absent end‐diastolic umbilical artery Doppler flow velocities. One hundred and ninety‐three infants survived to hospital discharge and were followed at 6‐monthly intervals until 48 mo of age. Fhe mean corrected developmental quotient was 94 ± 8 at 24 mo of age and 87 ± 9 at 48 mo. Ninety‐two percent of the infants had a developmental quotient of >80 at 24 mo and 72% at 48 mo of age. Fhis decline is thought to be due to the impact of social circumstances. Fhere were no differences between the developmental quotients of the infants with normal and those with absent end‐diastolic umbilical artery Doppler flow velocities at either 24 or 48 mo of age. At 24 mo of age, infants with absent end‐diastolic umbilical artery Doppler flow velocities scored lower in the Performance subscale test (p= 0.03).developmental quotients of infants from poorer socioeconomic backgrounds were significantly lower than those living in more privileged circumstances. At 48 mo, 153 (97%) of the children presented with normal gross motor development. Four infants had cerebral palsy. No differences were noted in the motor outcomes between the infants of women with normal umbilical artery waveforms and those with absent end‐diastolic umbilical artery Doppler flow velocities.
Neisseria meningitidis: evolution of penicillin resistance and phenotype in a children's hospital in Barcelona, Spain
Authors: Latorre C , Gene A , Juncosa T , Muñoz C , González‐Cuevas A 
Published: August 2010

Neisseria meningitidis is the most prevalent micro‐organism involved in paediatric bacterial meningitis in the Barcelona area in children over 3 mo of age and it is an important cause of morbidity and mortality in Spain. A total of 498 strains of N. meningitidis, obtained between the years 1986 and 1997 from children with sepsis and/or meningitis, were characterized according to their serogroup and penicillin resistance; their distribution in serotypes and subtypes was studied from 1990. A decreasing tendency in the number of annual isolates was observed in this period. Most isolates belonged to serogroups B (403 strains) and C (77 strains). Serogroup C accounted for 1.8% of the strains in 1986 and 57.1% in 1997. The most prevalent phenotype between 1990 and 1996 was B:4:P1.15, but C:2b:P1.2,5 was the most prevalent in 1997. Overall penicillin‐resistance rates ranged from 9.1% in 1986 (when a non‐susceptible strain was isolated for the first time in the Hospital Sant Joan de Deu, Barcelona, Spain) to 71.4% in 1997, and it was more common among strains belonging to serogroup C (52% of resistant strains) than to serogroup B (22.1% of resistant strains). The penicillin‐resistance level was low, MIC always <0.5 μg/ml. The present increase in N. meningitidis group C isolates, mainly C:2b:P1.2,5, and the availability of preventive measures for this highly pathological and resistant phenotype, argues strongly for the establishment of an epidemiological monitoring system. Detection of penicillin resistance should be standardized worldwide in order to unify data from all laboratories.Conclusion: A shift between serogroups B and C is observed in Barcelona from 1986 to 1997, as well as a rapid distribution of decreased penicillin susceptibility.
Prediction of vesico‐ureteric reflux in childhood urinary tract infection: a multivariate approach
Authors: Oostenbrink R , van der Heijden AJ , Moons KGM , Moll HA 
Published: August 2010

In this study, independent predictors obtained from patient history, physical examination and laboratory results for vesico‐ureteric reflux (VUR) in children of 0‐5 y with a first urinary tract infection (UTI) were assessed and the added value of renal ultrasound (US) investigated. Information was collected from children visiting the paediatric outpatient department with a first proven UTI, defined as a urine monoculture with ≥105 organism/ml, with clinical symptoms and possible white cell count ≥ 20 per high‐power field of spun fresh urine. Children with neurologic bladder dysfunction were excluded. VUR was determined by voiding cystourethrography (VCUG) and graded from I to V. The diagnostic value of predictors was judged using multivariate logistic modelling with the area under the receiver operating characteristic (ROC area). A risk score was derived based on the regression coefficients of the independent predictors in the logistic model. In 140 children (51 boys and 89 girls) VUR was diagnosed in 37. Independent predictors for VUR were male gender, age, family history for uropathology, serum C‐reactive protein level (CRP) and dilatation of the urinary tract on US. The ROC area of this model was 0.78 (95% CI: 0.69‐0.87). This prediction model identified 12% (95% CI: 7‐18) of the patients without VUR without missing one case of VUR. If we used VUR ≥ grade 3 as a threshold, the model assessed VUR to be absent in 34% (95% CI: 26‐42).Conclusion: A prediction rule based on age, gender, family history, CRP and US results is useful in assessing the probability of VUR in the individual child with a first UTI and may help the physician to make decisions about performing additional imaging techniques. Prospective validation of the model in future patients, however, will be necessary before applying the rule in practice.
Does nitric oxide prevent oxidative mediated lung injury?
Authors: Saugstad OD 
Published: August 2010

The US Food and Drug Administration recently approved nitric oxide (NO) inhalation therapy for newborn infants >34 wk of gestation with hypoxic respiratory failure associated with pulmonary hypertension. In clinical trials, this therapy has reduced the need for extracorporeal membrane oxygenation. It has not reduced mortality, however. A body of accumulating data indicates that NO may act as an antioxidant as well as a prooxidant, depending on a number of known and unknown factors, e.g. the concentration of NO itself and the concentration of other oxidants. In low doses, NO is an antioxidant and in high doses its prooxidant effects are more pronounced. In this issue of Acta Paediatrica, new information regarding this question has come to light. Turanlanthi et al. have found that NO in relatively high doses induces free radical mediated injury in the lungs of 10‐wk‐old Wistar rats, while in combination with hyperoxia it attenuates the oxidative stress of hyperoxia alone. Recently, it has also become clear that NO acts as a second messenger activating a number of cytokines and inducing apoptosis. There therefore seems to be a close relation between NO, oxidative stress, regulation of growth and inflammation. For these reasons, long‐term follow‐up studies of newborn infants treated with NO inhalation are needed. So far, NO therapy has not been successful in premature infants.Conclusions: NO inhalation has a number of both short‐term and long‐term potential adverse effects, and is still at the experimental stage in premature infants. Consequently, there is a need for further clinical studies monitoring also the long‐term consequences of this therapy.
Analysis of 20 years of prospective registration of childhood onset diabetes–time trends and birth cohort effects
Authors: Dahlquist G , Mustonen L ,   for the Swedish Childhood Diabetes Study Group
Published: August 2010

The Swedish Childhood Diabetes Registry has been recording all cases of childhood onset diabetes nationwide, with a high level of ascertainment, since 1 July 1977. The present report describes and analyses the 8358 childhood onset cases occurring between 1 January 1978 and 31 December 1997. The mean annual incidence was 26.4/100000 children per year (1978: 21.1 and 1997: 31.9). There was a significant log‐linear increase over time, with a mean annual increase of 1.7%. The steepest mean increase was seen among the young onset cases (2.5%) and the steepest yearly increase (6.3%) was seen in this age group during the last 10‐y period. A shift towards a younger age at onset was clearly indicated, as the age at onset was less during the last compared with the first 10‐y period of observation. The increase over time was similar between the sexes and during winter and summer. When analysing the six full birth cohorts covered, we found no clear‐cut shift in the trend. Birth cohorts (1978–82) up to 5y of onset showed a time variability but no clear trend over time. Ecological analyses associating cumulative incidence by birth cohort to breastfeeding frequency showed no significant association. A statistically significant log‐linear association was found to the official estimate of gross domestic product adjusted for similar price levels (p = 0.002). Conclusion: The incidence of childhood onset diabetes is rapidly increasing in Sweden, with a shift towards the younger age groups but with no trend in birth cohorts. Precipitating rather than initiating environmental risk factors are suggested, and the correlation to gross domestic product may suggest risk factors associated with wealth–such as a high growth rate, a known risk factor for childhood diabetes.
Outcome of congenital heart defects–a population‐based study
Authors: Meberg A , Otterstad JE , Frøland G , Lindberg H , Sørland SJ 
Published: August 2010

In a population‐based study including 35 218 infants born alive during the 15‐y period 1982–96, 360 (1%) were diagnosed as having a congenital heart defect (CHD). At a follow‐up 3–18 y after birth (median 9.5 y) 154 patients (42.8%) were spontaneously cured; of these, 142 (92.2%) had ventricular septal defects (VSDs). Forty‐two patients (11.7%) died, 22 of these (52.4%) during the neonatal period (0–28 d after birth). A total of 119 patients (33.1%) underwent therapeutic procedures (surgery, catheter interventions), 24 (20.2%) of whom died. Of the 95 children surviving therapeutic procedures, 54 (56.8%) had their defects completely repaired, while 41 (43.2%) had residual defects or cardiac sequelae, often of minor importance. In 69 children (19.2%) with persistent non‐operated defects, 43 (62.3%) had VSDs. A chromosomal disorder, syndrome or associated extracardiac malformation occurred in 72 children (20%). Conclusions: The study underlines the broad variety in severity of CHDs, with a high neonatal mortality rate as well as a high rate of spontaneous cure. It is estimated that 25% of infants born with a CHD will grow into adult age with persistent non‐operated defects, residual defects or cardiac sequelae after therapeutic procedures.
Epidemiology of pneumococcal infections in Swedish children
Authors: Eriksson M , Henriques B , Ekdahl K 
Published: August 2010

Objective: This paper provides an overview of pneumococcal infections in Swedish children. Method: Data supplied by the Swedish Institute for Infectious Disease Control (SMI) provided information on invasive pneumococcal isolates and on isolates with reduced susceptibility to penicillin. Disease burden was estimated from data collected in northern Stockholm and Malmöhus County. Results: Only 3–6% of the total number of invasive pneumococcal isolates came from children 0–15 years of age. Predominant serotypes in descending frequency were 7, 6, 14, and 23. Strains from all sources with reduced sensitivity to penicillin (MIC 0.5 mg/l) were found in 3% of children and varied between 0.2% and 11%, with the highest value found in Southern Sweden (predominating strains were 9, 19, 15, 6, and 23). A 10‐year review of all cases of meningitis in Northern Stockholm reflected an incidence of 10/100000 (0–2 years) or 5.8/100000 (0–5 years), with severe sequelae occurring in 20% of children. This information can be used to predict an annual incidence of 30 cases of meningitis in Sweden. Conclusion: The large proportion of serotype 7 among invasive isolates is distressing since this serotype is not represented in the present 7‐ and 9‐valent protein‐conjugated vaccines under development. However, the heptavalent vaccine, including serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F would (at a serotype level) provide coverage against 83% of the resistant isolates in Southern Sweden.
The mother‐offspring dyad and the immune system
Authors: Hanson LÅ 
Published: August 2010

A. The mother and the fetus. The mother's immune system reacts against the fetus and there is therefore a risk of destruction of or damage to the fetus. We are now beginning to understand some of the mechanisms that protect the fetus, but, when these are defective, intrauterine growth retardation or abortions may ensue. However, the cytokines of this maternal immune response to the fetus also monitor different phases of pregnancy, starting with effects on the ovarium and involving preparation of the decidua for the implantation of the fertilized egg, the growth of the trophoblasts, the production of hormones important for the pregnancy and finally of the prostaglandins that induce delivery. B. The mother and the child. Human milk contains anti‐idiotypic antibodies which after transfer to the offspring are capable of enhancing antibody responses. Human milk contains numerous leucocytes especially during early lactation. There is increasing evidence that milk lymphocytes are taken up by the breastfed infant, which seems to have become tolerant to maternal HLA. Breastfeeding mothers are therefore good donors of renal transplants to their breastfed offspring in adult age, too.Conclusion: It is suggested that the milk lymphocytes may be taken up by the offspring and that immunological information is thereby carried over from the mother. This mechanism may explain why breastfeeding seems to confer enhanced protection against infections also some years after the termination of breastfeeding.
Prevalence and characteristics of sexual abuse in a national sample of Swedish seventeen‐year‐old boys and girls
Authors: Edgardh K , Ormstad K 
Published: August 2010

The aims of this study, which was part of a survey on adolescent sexual behaviour, were to investigate adolescents' experience of child sexual abuse and to present possible abuse‐related problems. Representative samples of 2% of Sweden's 17‐y‐old male and female students and school non‐attenders were selected in a two‐step procedure. In all, 1943 students and 210 school non‐attenders answered a self‐administered anonymous questionnaire, distributed by school nurses. Six out of 170 questions dealt with personal experiences of child sexual abuse, i.e. age at onset, frequency of abuse and relationship to the offender. Peer abuse was excluded by the definitions used. The overall response rate was 92.2% for students and 44.2% for school dropouts. Among male and female students, 3.1% and 11.2%, respectively, acknowledged sexual abuse, 2.3% and 7.1%, respectively, when exhibitionism was excluded. Mean age at onset was 9.1 y (SD 4.3) for boys and 9.0 y (SD 3.9) for girls; 1.2% of the boys and 3.1% of the girls reported abusive oral, vaginal and/or anal intercourse. Suicide attempts or other acts of self‐harm were reported by 33.3% of the male students reporting abuse and by 5.1%(p <0.001) of those who had not been abused, and by 30.4% of the abused student girls compared to 9.1% of the non‐abused (p < 0.001). Sleep and eating disorders, use of alcohol at an early age and/or experimentation with illicit drugs and consensual coitarche before age 15 y was reported significantly more often by abused than non‐abused girls (p < 0.001, differences not found among the student boys). Of school non‐attenders, 4% of the boys and 28% of the girls reported sexual abuse. Of the abused girls, 49% reported abusive vaginal intercourse and 64% reported self‐destructive behaviour or suicide attempts. No abused boys and few abused girls had confided in a teacher, health professional or social worker.Results from the student sample should be interpreted as markers of “minimum prevalence”, as female school non‐attenders report significantly higher prevalence of sexual abuse. Potential high‐risk groups are better included in prevalence investigations of child sexual abuse. The fact that so few adolescents confided in “professionals” about the abuse, despite having severe symptoms and signs of distress, underlines the need to address sexual abuse when recording the social, medical and psychiatric histories of adolescents.
Parents' perception of mental development and behavioural problems in 8 to 9‐year‐old children
Authors: Larsson J‐O , Lichtenstein P , Fried I , El‐Sayed E , Rydelius PA 
Published: August 2010

A slow maturational rate may be an underlying antecedent of a psychiatric disorder. If this is correct, differences in behavioural problems could be related to the maturity level in children of the same chronological age. The aim of the study was to compare the parents' perceptions and assessments of their children's maturational status and behavioural problems. A population based on a nationwide sample from the Swedish twin‐register of 8 to 9‐y‐old children (n= 1079) was used. The parents completed a questionnaire including their views on their child's maturity level, the Swedish version of the Child Behaviour Checklist (CBCL) and an Attention Deficit Hyperactivity Disorder (ADHD) checklist based on the DSM‐III‐R criteria. Multivariate analyses showed a statistically significant relationship between immaturity reported by the parents and several behavioural problems reported on the CBCL: somatic complaints, anxious and depressed, social problems, thought problems, attention problems, behaviour problems and aggressive behaviour. There was also a statistically significant relationship between the maturity factor and the CBCL grouping of syndromes (internalizing, externalizing, total behaviour problems score) as well as between the maturity factor and ADHD. Conclusion: We conclude that at least from the parents' point of view the behaviour problems in their children may be related to maturity.
Sternal tuberculosis in a 9‐month‐old infant after BCG vaccination
Authors: Kato Y , Horikawa Y , Nishimura Y , Shimoda H , Shigeto E , Ueda K 
Published: August 2010

ABSTRACTTuberculosis osteitis is mainly observed as a late complication of the pulmonary infection. We describe a 9‐mo‐old Japanese infant who became infected with Mycobacterium tuberculosis even after receiving Bacillus Calmette‐Guérin (BCG) vaccination at 3 mo of age. This is the first report that the sternum is the localizatio n for tuberculou s osteitis in infants. He developed a localized tumor in the sternum without any respiratory symptom. Mycobacterium tuberculosis complex was detected by means of nucleic acid amplification test. Gastric aspirates also yielded Mycobacterium tuberculosis. The source of the infection was unclear. Conclusion: Tuberculous osteitis should be excluded in infants with undiagnosed bone lesions, even if they have been vaccinated with BCG. ±BCG vaccination, infant, Mycobacterium tuberculosis, sternum, tuberculous osteitis
Survey of the pre‐school child health surveillance programme in Sweden
Authors: Kornfält R 
Published: August 2010

A survey of the programme for developmental surveillance in the Child Health Centres (CHCs) in Sweden was performed using a questionnaire administered to the Chief Medical Officers (CMO) of the Child Health Services. The questionnaire asked about methods used for auditory examination, developmental surveillance and identification of disturbances in mother‐child interaction. Activities for health promotion concerning breastfeeding, non‐smoking and allergy prevention were also queried. Thirty‐four CMOs representing 1731 CHCs and 645000 children answered the questionnaire. The reply rate was 81%. Various methods of auditory examination are offered all infants and children in Sweden. The national guidelines for health supervision are followed fairly closely by all. Screening for disturbances in attention, motor development and perception (DAMP) is performed by all but four districts, with various methods, resources and degrees of co‐operation with school health services. Support in mother‐child interaction is considered very important and new methods to identify and treat disturbances are gradually introduced. Breastfeeding is encouraged; breast milk is the main source of food for 67% of babies at 4 mo of age. Activities to stop or diminish use of tobacco are ongoing everywhere, as are programmes to identify children at risk of developing allergies and for allergy prevention.Thus, the Child Health Services maintain a high standard and are ambitious about introducing new methods and ideas.