bluuebunny/crossref_metadata_2025_split huggingface dataset:
Altered bone metabolism in children infected with human immunodeficiency virus
Authors: Zamboni G , Antoniazzi F , Bertoldo F , Lauriola S , Antozzi L , Tatò L 
Published: August 2010

Aim: Data on bone homoeostasis of children infected with human immunodeficiency virus (HIV), at the time of the gain in bone mass, are very rare. To determine possible alterations in bone metabolism, 13 prepubertal vertically HIV‐infected children were studied. Methods: Viral load, CD4 count, interleukin‐6 (IL‐6), growth hormone, insulin‐like growth factor‐I (IGF‐I), IGF binding protein‐3 (IGFBP‐3), acid‐labile subunit (ALS), IGFBP‐3 proteolysis, osteocalcin in blood and N‐terminal telopeptide of type I collagen in urine were determined. Lumbar spine bone mineral density was examined by dual‐energy X‐ray absorptiometry. Results: Low osteocalcin levels were found in all patients. Low IGF‐I was found in only six children, who had low CD4 count and high IL‐6 levels, with normal levels of IGFBP‐3 and ALS, absent IGFBP‐3 proteolysis and decreased bone mineral density, irrespective of viral load or growth. Conclusion: Low serum osteocalcin levels appear to be an initial warning sign of possible altered bone metabolism in HIV‐infected children. However, only when the immune system becomes more seriously compromised is bone loss measurable by bone densitometry.
Investigation of the mechanisms of therapy‐related hypoglycaemia in children with acute lymphoblastic leukaemia
Authors: Halonen P , Salo MK , Schmiegelow K , Mäkipernaa A 
Published: August 2010

Aim: To determine the mechanisms of fasting hypoglycaemia occurring during maintenance therapy (MT) for childhood acute lymphoblastic leukaemia (ALL). Methods: Thirty‐five children and adolescents with ALL, aged 2.4–17.4 y, were fasted for up to 16 h during MT. Nineteen of the children developed hypoglycaemia after 11 to 16 h of fasting. Blood samples for determination of metabolic changes were taken on completion of fasting. Nineteen patients underwent a glucagon stimulation test after 4 to 16 h of fasting during MT. Erythrocyte concentrations of the metabolites of methotrexate (E‐MTX) and 6‐mercaptopurine (E‐TGN) were measured at the time of fasting. Fifteen out of 19 patients who became hypoglycaemic were re‐studied 3 to 4 mo after cessation of therapy. Results: In the hypoglycaemia group, plasma levels of gluconeogenic amino acids alanine and glutamine were lower (medians 117 vs 190 μmol L−1, p= 0.009, and medians 396 vs 448 μmol L−1, p= 0.031, respectively) than in the normoglycaemia group. Serum levels of free carnitine were lower (medians 20.3 vs 29.8 μmol L−1, p= 0.027), free fatty acids higher (medians 3.09 vs 1.23 mmol L −1, p < 0.001) and marked dicarboxylic aciduria was more common in the patients with hypoglycaemia (in 14/16 vs in 2/14, p < 0.001). Impaired responses to glucagon stimulation occurred in 36% (4/11) in the hypoglycaemia group and in 12.5% (1/8) in the normoglycaemia group (p= 0.243). No significant differences were detected in E‐MTX and E‐TGN between the groups. Most of the metabolic abnormalities returned to normal after cessation of chemotherapy. Conclusions: Low levels of gluconeogenic amino acids, especially of alanine, are associated with hypoglycaemia. Reduced hepatic glycogen stores may also be involved in the aetiology.
Factors constraining adherence to referral advice for severely ill children managed by the Integrated Management of Childhood Illness approach in Imbabura Province, Ecuador
Authors: Kalter HD , Salgado R , Moulton LH , Nieto P , Contreras A , Egas ML , Black RE 
Published: August 2010

Aim: Low referral completion rates in developing countries undermine the Integrated Management of Childhood Illness (IMCI) strategy for lowering child mortality. This study sought to identify factors constraining adherence to referral advice in a health system using the IMCI approach. Methods: Caregivers of 160 children urgently referred to hospital were prospectively interviewed. Caregivers who accessed and did not access hospital were compared for potential referral constraining factors, including demographics, family dynamics, the severity of their child's illness, their interaction with the health system, self‐perceived problems, and physical and financial access. Results: 67/160 (42%) referred children did not access hospital. Six factors were associated with non‐access, including two health worker actions: not being given a referral slip [adjusted odds ratio (OR)= 15.3, 95% confidence interval (95% CI) 4.4–64.6) and not being told to go to the hospital immediately (adjusted OR = 5.3, 95% CI 1.9–16.3). Receiving both of these interventions reduced the risk of not accessing hospital to 19%, from 96% for those who received neither intervention. Several indicators of illness severity, including caregivers' ranking of their children's illness severity, the presence of severe illness signs and mortality, were investigated and found not to be important explanatory factors. Conclusion: Providing a referral slip and counseling the caregivers of severely ill children to go to the hospital immediately appear to be powerful tools for increasing successful referral outcomes.
The respiratory pump: past and present understanding
Authors: Devlieger H 
Published: August 2010

The history of our understanding of the respiratory system has been long and progressive, probably starting with Galenus who did experimental spinal cord sections, and progressed through the poorly known work of Leonardo da Vinci on the structure‐function relation of chest wall components.Conclusion: Despite numerous experiments in the past, the respiratory control system remains complex and poorly integrated because of the diversity of the afferent pathways and of the interacting respiratory centres.
β‐Glucuronidase in the diagnosis of bacterial meningitis and response to treatment
Authors: Beratis NG , Eliopoulou MI , Syrogiannopoulos GA 
Published: August 2010

Aim:β‐Glucuronidase activity is increased in the cerebrospinal fluid (CSF) of patients with bacterial meningitis. The aim of this study was to investigate the β‐glucuronidase activity in the cell‐free CSF of bacterial meningitis and its course during treatment, and compare it with other CSF parameters. Methods: The β‐glucuronidase activity, cell number, protein concentration and CSF/blood glucose ratio were measured in 43 consecutive infants and children with bacterial meningitis, and 97 control subjects. Patients had one or two follow‐up lumbar punctures. Results: The β‐glucuronidase activity was increased early in bacterial meningitis, even when the other CSF parameters were undisturbed. Before treatment, the median activity in affected children was 136umoles 4‐methylumbelliferone l‐1 h‐1 (range 44–826) and in controls 14 (7–23). In all patients who improved, the activity was lower in the follow‐up CSF samples. Six to 12 h after starting treatment, the median activity was already reduced by 59%. The other CSF parameters showed a variability during the first 24 h of treatment independently of the course of the disease. Multiple comparisons of the CSF parameters in 17 patients who had two follow‐up punctures showed that the β‐glucuronidase activity was the best prognostic index. Conclusion: β‐Glucuronidase activity in the CSF is a reliable indicator of bacterial meningitis, which can identify the response to treatment early in the course of illness. The enzyme activity is increased early in the disease, even when the other laboratory parameters from the CSF remain normal.
Preterm delivery and calculation of survival rate below 28 weeks of gestation
Authors: Hansen B Mølholm , Greisen G 
Published: August 2010

Aim: To estimate the number of still‐ and live‐births below 28 wk of gestation in a 2‐y period in Denmark, and to determine how the calculated survival rates vary using three different denominators: 1) the number of infants actively treated in the Neonatal Care Units, NNUs, 2) the number of all live‐born infants, and 3) the number of all births, including stillbirths. Methods: The number of stillbirths and live‐born infants at 20 to 27 wk of gestation was estimated over a 2‐y period in Denmark. Data on live‐born infants and survival rates were obtained from a national prospective study and the National Births Register. The number of women hospitalized owing to spontaneous abortion was obtained from The Danish National Health Register; the number of stillbirths was calculated from these data. Results: The estimated number of both still‐ and live‐births was similar in every week from 20 to 27 wk of gestation; approximately 1 per 1000 live‐births at each gestational week. At from 23 to 25 wk of gestation the overall chances of survival varied significantly depending on the denominator: actively treated infants 46% (CI 95%; 37%‐54%), all live‐born infants 34% (CI 95%; 27%–41%), all births including stillbirths 14% (CI 95%; 11%–17%). Conclusion: The chances of survival for the intrauterine fetus below 26 wk of gestation are significantly lower than the reported survival rates from the NNUs. The low percentage of fetuses delivered before 26 wk of gestation classified as live‐born renders the reported birth‐rates sensitive to differences in the way “live‐born” is interpreted.
Infant feeding practices and associated factors in the first six months of life: The Norwegian Infant Nutrition Survey
Authors: Lande B , Andersen LF , Bærug A , Trygg KU , Lund‐Larsen K , Veierød MB , Bjørneboe G‐E Aa 
Published: August 2010

Aim: To describe and evaluate infant feeding practices during the first 6 mo of life in relation to recommendations, and to study infant feeding practices in relation to maternal and infant characteristics. Methods: Data from 2383 Norwegian infants aged 6 mo were collected by a self‐administered semi‐quantitative food‐frequency questionnaire measuring feeding practices at 6 mo and feeding practices retrospectively at ≤5.5 mo of age. Results: Only 1% of the infants had never been breastfed. The proportion of breastfed infants was 96% at 1 mo, 85% at 4 mo and 80% at 6 mo. The proportion of exclusively breastfed infants was 90% at 1 mo, 44% at 4 mo and 7% at 6 mo. Twenty‐one percent of the infants were introduced to solid foods before the age of 4 mo. For exclusive breastfeeding at 4 mo, breastfeeding at 6 mo and timely introduction of solid foods (not before 4 mo) significant positive trends were found for maternal age, education and degree of urbanization. Negative associations were found for maternal smoking. Furthermore, exclusive breastfeeding at 4 mo was associated with infant gender and marital status, and the odds of breastfeeding at 6 mo significantly decreased with decreasing infant birthweight. Finally, both the odds of exclusive breastfeeding at 4 mo and of breastfeeding at 6 mo increased with increasing numbers of children. Conclusion: These results indicate that a majority of Norwegian infants are fed in accordance with infant feeding recommendations during their first 6 mo of life. However, the duration of exclusive breastfeeding is shorter than recommended. Infant feeding practices are significantly associated with maternal and infant characteristics.
Results of exercise testing at a mean age of 10 years after neonatal arterial switch operation
Authors: Hövels‐Gürich HH , Kunz D , Seghaye M‐C , Miškova M , Messmer BJ , von Bernuth G 
Published: August 2010

Aim: This prospective follow‐up study investigated long‐term exercise capacity at a mean age of 10 y after neonatal arterial switch operation for transposition of the great arteries in a large group of homogeneous unselected children. Methods: 56 asymptomatic children, aged 7.9–14.3 y (10.5 ± 1.6, mean ± SD), were examined with respect to exercise tolerance, electrocardiographic (ECG) response and activity of biochemical markers for myocardial injury. The protocol included standard electrocardiography, M‐mode and two‐dimensional echocardiography at rest, a Bruce walking treadmill test to voluntary exhaustion, and determination of cardiac troponin I and T, creatine kinase and myoglobin from venous blood samples at rest and 4 h after exercise. Heart rate, blood‐pressure response to exercise stress and endurance time were compared with published results of age‐matched normal children. Results: 54 patients (96.4%) had normal exercise capacity; a reduction in 2 patients was not due to cardiac disease. Heart rate and systolic blood pressure rose significantly between rest and peak exercise and did not differ from normal controls, whereas diastolic blood pressure was lower. ECG remained normal at rest and on exercise in 54 children (96.4%). Serum values of cardiac troponin I and T, creatine kinase and myoglobin were normal at rest and after exercise in all patients. Conclusion: The study demonstrates excellent long‐term exercise capacity after neonatal arterial switch operation. Exercise testing is a useful and non‐invasive screening method to detect patients with clinically relevant exercise‐induced myocardial ischaemia and should be routinely performed in growing patients.
Knee‐heel length measurements in preterm infants: evaluation of a simple electronically equipped instrument
Authors: Engström E , Wållgren K , Hellström A , Niklasson A 
Published: August 2010

Aim: To compare and evaluate a mini‐knemometer with a simple and inexpensive electronic caliper with regard to precision, handling error (technical error) and estimation of growth velocity. Methods: Thirty‐five prematurely born infants, with a median gestational age of 29 (range 24–33) wk and a median birthweight of 960 (range 480–2480) g, were measured on 409 different occasions with both instruments. On each occasion, five independent readings were made. Results: There was no significant difference in precision between the two instruments, when measuring growth velocity over a 4 wk period (median 0.41, range 0.10–0.59 mm d−1). The handling error in this study, calculated as the mean standard deviation, was 0.36 (SD 0.18, coefficient of variation 0.38%) mm for the simple electronic caliper and 0.59 mm for the mini‐knemometer. Short‐term growth was detectable within 2 d when growth velocity was normal. Conclusion: Longitudinal measurement of lower leg length is a gentle and useful complementary method for assessing growth in preterm infants. An inexpensive electronic caliper is well suited for routine use in clinical practice, with measurements taken once or twice a week.
Rehospitalization for respiratory syncytial virus infection in infants with extremely low gestational age or birthweight in Denmark
Authors: Pedersen O , Herskind AM , Kamper J , Nielsen JP , Kristensen K 
Published: August 2010

Aim: To determine the risk of rehospitalization for respiratory syncytial virus (RSV) infection during the first 2 y of life in extremely preterm infants. Methods: Records on all rehospitalizations during the first 2 living years of all infants born with gestational age < 28 wk or birthweight < 1000g during 1994 and 1995 in Denmark were retrospectively reviewed. Results: Among 240 eligible infants, 43 (18%) had been rehospitalized 48 times owing to RSV. In infants (n= 210) without CLD the risk of rehospitalization for RSV was 16%, whereas in infants with CLD (n= 30) it was 30% (p= 0.065). Eighteen infants (38%) required respiratory support (supplemental oxygen only 3, continuous positive airway pressure 14, mechanical ventilation 1). Apart from CLD the only factor that could be associated with increased risk of hospitalization for RSV was discharge during autumn (p= 0.05). No infant died from RSV infection. Conclusion: The high rate of rehospitalization for RSV in extremely preterm infants in Denmark, especially in infants with CLD, should lead to considerations concerning more widespread use of prophylaxis against RSV in these infants.
Spontaneous intestinal perforation and Candida peritonitis presenting as extensive necrotizing enterocolitis
Authors: Robertson NJ , Kuna J , Cox PM , Lakhoo K 
Published: August 2010

Spontaneous intestinal perforation (SIP) has been increasingly reported in very‐low‐birthweight (VLBW) infants, although it is still less common than necrotizing enterocolitis (NEC). In around one‐third of cases, SIP is associated with systemic candidiasis. We describe a case of SIP and Candida peritonitis in a VLBW infant, which was mistakenly diagnosed as NEC during the infant's short life. At laparotomy, the bowel surface was black and thought to be necrotic. As the infant was thought to have whole‐bowel necrosis due to NEC, her condition was deemed incompatible with survival. At postmortem, however, the bowel wall was found to be healthy apart from a very localized patch of necrosis associated with a single perforation. The bowel was covered by a thick, black, serosal exudate consisting of fungal elements from Candida albicans. Conclusion: This case reinforces the fact that a markedly discoloured bowel is not necessarily necrotic and that the discoloration can potentially recover.
Intended plans for breastfeeding duration: a simple tool to predict breastfeeding outcome
Authors: Vogel AM 
Published: August 2010

Prenatal intended duration of breastfeeding has been shown to be a powerful predictor of breastfeeding initiation and duration. This provides a tool to establish the risks for short duration of breastfeeding. Conclusion: It is necessary to identify the factors that influence mothers' plans, and to find means to intervene effectively.
Beneficial effects of postnatal skin‐to‐skin contact
Authors: Kennell JH , McGrath SK 
Published: August 2010

In a randomized trial, Bystrova et al. examined the traditional neonatal practice of swaddling. They demonstrated that extended skin‐to‐skin contact with the mother is the most effective way to maintain the infant's temperature and decrease the “stress of being born”. Conclusion: Only through research such as that reported by Bystrova et al. can the advantages or disadvantages of routinely accepted perinatal practices be evaluated.
Ultrasonic tissue characterization of the myocardium in anorexia nervosa
Authors: Franzoni F , Galetta F , Cupisti A , Rolla M , Santoro G , Pentimone F 
Published: August 2010

Aim: To determine the systodiastolic variations in the integrated backscatter (IBS) signal of the myocardium in patients with anorexia nervosa. Methods: 25 young women (aged 22.4 ± 4.3 y) with overt anorexia nervosa, compared with 25 age‐matched thin and 25 age‐matched control women with body mass index >20 kg m−2, underwent either conventional two‐dimensional echocardiography or analysis of IBS cyclic variations. Results: Compared with thin and control subjects, anorectic patients showed reduced left ventricular mass (LVM: 82.9 ± 17.1 vs 119.9 ± 13.8 and vs 126.12 ± 16.4 g, p < 0.0001; LVM indexed 21.4 ± 3.3 vs 29.4 ± 2.5 and vs 31.2 ± 3.1 g m−2.7, p < 0.0001), and IBS cyclic variations (septum: –0.49 ± 2.18 vs 6.86 ± 1.3 and vs 6.61 ± 1.74 dB, p < 0.0001; posterior wall: 2.77 ± 2.12 vs 7.15 ± 2.12 and vs 7.48 ± 2.23 dB, p < 0.01). Conclusion: Anorexia nervosa is associated with a significant reduction in the cyclic variation in IBS, which is also related to left ventricular hypotrophy. Ultrasonic tissue characterization could give an objective approach for the detection of myocardial structural properties and represent a preclinical index of myocardial dysfunction in anorexia nervosa.
How reliable is axillary temperature measurement?
Authors: Falzon A , Grech V , Caruana B , Magro A , Attard‐Montalto S 
Published: August 2010

Aim: To assess whether axillary temperature measurements reliably reflect oral/rectal temperature measurements. Methods: This observational study compared paired axillary‐rectal and axillary‐oral temperatures in a general paediatric ward with the participation of 225 children aged ≤4 y and 112 children aged between 4 and 14 y. Results: Changes in oral/rectal and axillary temperatures correlated significantly (p < 0.0001). However, axillary temperature measurements were significantly lower than both oral (mean ‐0.56°C, SD 0.76°C) and rectal measurements (0.38°C; SD 0.76°C). Ninety‐five percent of axillary measurements fell within a 2.5–3°C range around respective paired oral/rectal measurements. The mean difference increased with increasing temperature, and was 0.4°C at low body temperatures, and over 1°C with a fever of 39°C. Neither seasonal fluctuations nor the amount of clothing worn influenced this difference. Conclusion: Axillary temperatures in young children do not reliably reflect oral/rectal temperatures and should therefore be interpreted with caution.
Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study
Authors: Donath SM , Amir LH ,   The ALSPAC Study Team
Published: August 2010

Aim: To report the relationship between maternal prenatal intention to breastfeed and the actual initiation and duration of breastfeeding. Methods: Pregnant women resident within Avon, UK, expected to give birth between 1 April 1991 and 31 December 1992 were recruited in a longitudinal cohort study. Main outcome measures included maternal infant feeding intention (breastfeed, breast and bottle feed, bottle feed, or uncertain) at 32 wk of pregnancy; intention in the first week, intention for the rest of the first month and intention in months 2 to 4; initiation and duration of breastfeeding up to six months. Results: Data were available on 10548 women. Prenatal intention to breastfeed had an influence on both initiation and duration of breastfeeding. Of the women intending to bottle feed from birth, only 3.4% initiated breastfeeding compared with 96.6% of women planning to breastfeed for at least four months. At six months postpartum, the mean duration of breastfeeding for women intending to breastfeed for at least five months was 4.4 mo (95% CI 4.3, 4.4), compared with 2.5 mo (95% CI 2.4, 2.6) for women with a prenatal intention to breastfeed for only one month. Logistic regression, using intended duration as the only explanatory variable, correctly predicted 91.4% of breastfeeding initiation and 72.2% of infant feeding at six months. Conclusions: This large population‐based study confirms the strength of the relationship between maternal prenatal intention to breastfeed and both breastfeeding initiation and duration. Maternal intention was a stronger predictor than the standard demographic factors combined. This should be taken into account in future research, and trials should be undertaken to establish whether interventions could alter maternal intention and thereby increase rates of breastfeeding initiation and duration.