bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monitoring breastfeeding rates in Italy: national surveys 1995 and 1999
Authors: Giovannini M , Banderali G , Radaelli G , Carmine V , Riva E , Agostoni C 
Published: August 2010

Aim: To assess and compare the rates of initiation and duration of breastfeeding in Italy in 1995 and 1999, and to examine the adherence to the ten steps to successful breastfeeding recommended by WHO. Methods: Two cohorts of mothers who delivered healthy infants in November 1995 (n= 1601) or November 1999 (n= 2450) were interviewed by telephone within 4 wk of delivery and when their infant were 3, 6, 9 and 12 mo of age. Type of breastfeeding was classified according to the WHO definitions. Adherence to the WHO ten steps was evaluated as experienced by the mothers. Results: Initiation and duration of breastfeeding increased during the 1995–1999 period (p < 0.0001). The rate of breastfeeding at birth, at discharge and when the infants were 3, 6, 9 and 12 mo of age was 85%, 83%, 42%, 19%, 10% and 4%, in 1995 and 91%, 89%, 66%, 47%, 25% and 12% in 1999. The rate of exclusive breastfeeding was higher in 1999 than 1995 at birth (39% vs 30%, p < 0.0001) and at discharge (77% vs 70%, p < 0.0001), but overall no longer duration was observed in 1999. At 4 and 6 mo of age the rate of exclusive breastfeeding was 25% and 8% in 1995 and 31% and 5% in 1999. The adherence to each WHO step was higher in 1999 than in 1995 (p < 0.05) but concomitant adherence was low (<3%). Conclusion: Although an increase in initiation and duration of breastfeeding occurred in Italy during the 1995–1999 period, the duration of breastfeeding and exclusive breastfeeding is currently unsatisfactory, as is adherence to the ten steps specified by WHO. Promotion of breastfeeding and education and improvement in adherence to the WHO recommendations are still needed in Italy.
Extemporaneous (magistral) preparation of oral medicines for children in European hospitals
Authors: Conroy S 
Published: August 2010

The lack of availability of licensed paediatric medicines forces pharmacists to compound drugs into a form that children can tolerate. There is a lack of information to support much of this practice and standards tend to vary. Suitable licensed alternatives are often available in other countries but importing restrictions complicate obtaining them. Conclusion: Regulatory action is needed to simplify licensing and importation processes to facilitate universal access to suitable paediatric medicines.
Concentrations of dioxins and other organochlorines (PCBs, DDTs, HCHs) in human milk from Seveso, Milan and a Lombardian rural area in Italy: a study performed 25 years after the heavy dioxin exposure in Seveso
Authors: Weiss J , Päpke O , Bignert A , Jensen S , Greyerz E , Agostoni C , Besana R , Riva E , Giovannini M , Zetterström R 
Published: August 2010

Aim: To investigate whether those who were exposed to high levels of the dioxin TCDD 25 years ago in Seveso, northern Italy still have higher than the expected levels of dioxins in their fat stores, and to investigate the concentrations of dioxins in the breast milk of mothers in Seveso and in two other regions in Italy. The load of vertically transmitted dioxins to the next generation, if being breastfed, was also investigated. Methods: As there may be a synergistic effect of mixtures of organic chlorines, the concentrations of pesticides such as DDTs and PCBs have also been studied in the same human milk samples. Breast milk from 12 mothers from Seveso, Central Milan and a Lombardian village was collected for analysis during the first week and 1 and 3 mo after delivery. Individual samples were used for the analysis of pesticides and PCBs, whereas dioxins were analysed in pooled samples from all 12 mothers on each occasion. Results: In human milk from Seveso, the TCDD concentration in fat calculated on a fresh weight basis was more than twice as high as the level in the other two regions, whereas the concentrations of investigated other toxins were lower in Seveso possible due to induction of the enzyme cytochrome P4501A, which means that the total level of dioxins was the same in all three locations. The congener profile, measured as mean toxic equivalency (TEQ) values, was the same in the Italian samples as previously reported from Stockholm. The calculations are based on the most recent WHO TCDD equivalency factors (TEF). The DDE concentration was higher in the samples from Milan than in the samples from the other two Italian regions, which may be due to the fact that, to a greater extent than in the other regions, Milanese food is imported from countries where DDT is still used as a pesticide. Conclusion: Twenty‐five years after the dioxin catastrophe, human milk from mothers in Seveso has concentrations of the highly toxic dioxin congener TCDD that are more than twice as high as those in central Milan and a Lombardian village. This means that breastfed infants in Seveso still store an appreciable amount of TCDD in their body fat. The health consequences of this fact remain to be elucidated. The effect of the high load of DDTs in central Milan also has to be considered
Cost of hospitalization for respiratory syncytial virus chest infection and implications for passive immunization strategies in a developing nation
Authors: Chan PW‐K , Abdel‐Latif ME‐A 
Published: August 2010

Respiratory syncytial virus (RSV) chest infection is a common cause of hospitalization in the very young child. The aim of this study was to determine the direct cost of resource utilization in the treatment of children hospitalized with RSV chest infection and the potential cost‐savings with passive immunization for high‐risk infants. An audit of the hospital resource consumption and its costs was performed for 216 children aged <24 mo admitted with RSV chest infection between 1995 and 1997. The cost‐saving potential of passive immunization using monoclonal RSV antibodies during the RSV season was determined by assuming an 0.55 efficacy in hospitalization reduction when administered to “high‐risk” infants according to the guidelines outlined by the American Academy of Pediatrics (AAP). The hospital treatment cost of 1064 bed‐days amounted to USD 64 277.70. Each child occupied a median of 4.0 bed‐days at a median cost of USD 169.99 (IQ1 128.08, IQ3 248.47). Children, who were ex‐premature or with an underlying illness were more likely to have a longer hospital stay, higher treatment costs and need for intensive care. Ten (42%) of 24 ex‐premature infants fulfilled the recommended criteria for passive immunization. Its use resulted in an incremental cost of USD 31.39 to a potential cost saving of USD 0.91 per infant for each hospital day saved. Conclusion: Ex‐prematurity and the presence of an underlying illness results in escalation of the direct treatment cost of RSV chest infection. Current guidelines for use of passive RSV immunization do not appear to be cost‐effective if adopted for Malaysian infants.
Transferrin receptor in children and its correlation with iron status and types of milk consumption
Authors: Bramhagen A‐C , Virtanen M , Siimes MA , Axelsson I 
Published: August 2010

Aim: This study compared transferrin receptor (TfR) concentrations with iron parameters relative to a child's intake of cow's milk and follow‐on formula.Methods: TfR, β‐haemoglobin, serum ferritin and mean corpuscular volume (MCV) of red blood cells were analysed in a study population of 263 children aged 2.5 y. The amounts of cow's milk and follow‐on formula consumed were recorded.Results: There was a significant difference in concentrations of TfR/log ferritin between children whose milk intake was <500 ml and those with a milk intake ≥500 ml (p= 0.003). There were significantly higher values of TfR/log ferritin in children whose MCV of red blood cells was ≤75 fl than in those with >75 fl (p< 0.0001). The TfR concentrations were significantly lower after iron therapy than before treatment.Conclusion: Higher concentrations of TfR were correlated with lower concentrations of haemoglobin and MCV of red blood cells. Milk consumption increases the risk of a higher ratio of TfR/log ferritin. TfR concentrations were significantly lower after iron therapy.
Development of a conceptual tool for the implementation of kangaroo mother care
Authors: Bergh A‐M , Pattinson RC 
Published: August 2010

Aim: To develop a conceptual tool to assist healthcare workers and management in the implementation of a kangaroo mother care programme. Methods: A qualitative research approach was followed and methods included on‐site observations and informal conversational interviews, as well as unstructured, in‐depth interviews with senior managers, doctors and nurses at two large training hospitals in the north of South Africa. A consultative process was used to refine the tool. Results: The patterns that emerged from the data were captured in a diagram, entitled: “Main issues in the establishment of kangaroo mother care”. In addition, a set of core questions was developed to assist in decision‐making at institutional level. Conclusion: The diagram and questions contain concepts that could be adapted and used by a healthcare facility's multidisciplinary team in planning the implementation of kangaroo mother care and in reviewing the progress made in the implementation and the quality of the kangaroo mother care provided.
Coordination of suck‐swallow and swallow respiration in preterm infants
Authors: Lau C , Smith EO , Schanler RJ 
Published: August 2010

Safe oral feeding of infants necessitates the coordination of suck‐swallow‐breathe. Healthy full‐term infants demonstrate such skills at birth. But, preterm infants are known to have difficulty in the transition from tube to oral feeding. Aim: To examine the relationship between suck and swallow and between swallow and breathe. It is hypothesized that greater milk transfer results from an increase in bolus size and/or swallowing frequency, and an improved swallow‐breathe interaction. Methods: Twelve healthy preterm (<30 wk of gestation) and 8 full‐term infants were recruited. Sucking (suction and expression), swallowing, and respiration were recorded simultaneously when the preterm infants began oral feeding (i.e. taking 1–2 oral feedings/d) and at 6–8 oral feedings/d. The full‐term infants were similarly monitored during their first and 2nd to 4th weeks. Rate of milk transfer (ml/min) was used as an index of oral feeding performance. Sucking and swallowing frequencies (#/min), average bolus size (ml), and suction amplitude (mmHg) were measured. Results: The rate of milk transfer in the preterm infants increased over time and was correlated with average bolus size and swallowing frequency. Average bolus size was not correlated with swallowing frequency. Bolus size was correlated with suction amplitude, whereas the frequency of swallowing was correlated with sucking frequency. Preterm infants swallowed preferentially at different phases of respiration than those of their full‐term counterparts. Conclusion: As feeding performance improved, sucking and swallowing frequency, bolus size, and suction amplitude increased. It is speculated that feeding difficulties in preterm infants are more likely to result from inappropriate swallow‐respiration interfacing than suck‐swallow interaction.
Prediction of respiratory distress syndrome by the microbubble stability test on gastric aspirates in newborns of less than 32 weeks’gestation
Authors: Verder H , Ebbesen F , Linderholm B , Robertson B , Eschen C , Arrøe M , Lange A , Grytter C , Bohlin K , Bertelsen A ,   for the Danish‐Swedish Multicentre Study Group
Published: August 2010

Aim: There is a need for a rapid method to identify infants who will develop respiratory distress syndrome (RDS) soon after birth, to allow early treatment of affected infants with surfactant. The microbubble stability test (MST) may be one such method, but clinical experience is sparse. Methods: The MST was performed on gastric aspirates from 188 infants with a mean gestational age of 29 (range 23–31) wk. Results: 87 infants developed moderate to severe RDS, corresponding to a prevalence of 46%. The sensitivity, specificity and predictive values for identification of infants with moderate to severe RDS were determined for the average diameter of bubbles, the proportion of microbubbles with different diameters and the total number of microbubbles. The proportion of microbubbles with diameters <20 or 25 urn gave the best prediction, with a sensitivity of 78–79%, a specificity of 57–58%, a positive predictive value of 62% and a negative predictive value of 76%. Early treatment with nasal continuous positive airway pressure probably mitigated the development of RDS in some infants with a low‐degree surfactant deficiency and this may explain the relatively low specificity. Conclusion: In infants of <32wk gestation RDS can be predicted by computerized image analysis of the size distribution of microbubbles generated in gastric aspirates.
Age at diagnosis of vesicoureteric reflux after urinary infections: historical changes
Authors: Marra G , Oppezzo C , Barberis V , Bianchetti MG 
Published: August 2010

Aim: Efforts are currently made to detect vesicoureteric reflux (VUR) early after urinary infections in order to limit secondary renal damage. This study investigated the extent to which recommendations for the detection of VUR are put into practice, and their influence on the age at diagnosis. Methods: The age at diagnosis of VUR after urinary tract infections was analysed in 126 patients (48M, 78F) referred to a tertiary centre in Milan between 1976 and 1999. Results: The median age at diagnosis was 34 mo in subjects born before and 8 mo (p < 0.001) in those born after 1988. The difference was statistically significant in female but not in male subjects. The figures from Milan were compared with those for 102 patients (35M, 65F) born between 1946 and 1970, treated in Melbourne and reported in 1976. In Melbourne the median age at diagnosis was 1–2 y for boys and 5–6 y for girls; in Milan, the corresponding figures were <1y and 1–2 y. The difference between Melbourne and Milan was statistically significant for both genders. Conclusion: In Milan VUR is now detected earlier than in the past. This trend is more marked in females than in males, but reflux is still detected earlier in boys.
Epidemiology of childhood type I diabetes in Crete, 1990–2001
Authors: Mamoulakis D , Galanakis E , Bicouvarakis S , Paraskakis E , Sbyrakis S 
Published: August 2010

Aim: To study the epidemiological patterns of childhood‐onset type I diabetes in Crete, Greece. Methods: The incidence (new cases per 100000 per year) from 1990 to 2001 was determined in the population of Crete ≤14 y of age. Results: A total of 89 cases was ascertained. The standardized annual incidence rate was 6.1 per 100000 population [95% confidence interval (95% CI) 4.9‐7.5]. Incidence rates were higher in children 10–14 y of age, boys and residents of urban areas (6.8, 6.7 and 6.6 per 100000, respectively). Incidence rates were higher [relative risk (RR) 1.46, 95% CI 0.956‐2.24] during the 6 y period 1996–2001 (7.2, 95% CI 5.4‐9.4) than during the 6 y period 1990–1995 (4.9, 95% CI 3.4‐6.9). This increase was more prominent in residents of urban areas and 10–14‐y‐old children. Conclusions: Although an increase was noted during the period 1990–2001, the childhood type I diabetes incidence rates in Crete remain among the lowest both in Europe and in the Mediterranean islands.
Postnatal dexamethasone: what is the real cost‐benefit ratio?
Authors: Halliday HL 
Published: August 2010

Postnatal corticosteroids given early after birth reduce the risk of chronic lung disease in preterm infants but are associated with an approximate doubling of the risk of adverse neurosensory outcomes. Corticosteroids given after 7–10 d of age appear not to have these increased risks of neurosensory sequelae and reduce time on the ventilator. Conclusion: Further research is needed to determine the lowest dose of corticosteroid that will improve lung function and minimize risks to the developing brain.
Early chemotherapy for non‐tuberculous mycobacterial infections in patients with cystic fibrosis
Authors: Forslöw U , Geborek A , Hjelte L , Petrini B , Heurlin N 
Published: August 2010

Aim: To evaluate the response rate to antimycobacterial drug therapy in patients with cystic fibrosis (CF) suffering from infection by non‐tuberculous mycobacteria (NTM). Methods: Ten patients, aged 10–34 y, out of 180 CF patients, were diagnosed with NTM disease. They had been regularly checked and examined for pulmonary symptoms, and had had chest X‐rays and sputum cultures (including for mycobacteria) performed. One additional 36‐y‐old female received her CF diagnosis soon after the NTM diagnosis. Results: Mycobacterium avium‐intracellulare complex (MAC) was found in 10 out of 11 patients and M. kansasii in 1 patient. Treatment with antimycobacterial drugs resulted in clinical improvement (weight gain or stabilization of weight and/or improved or stabilized lung function in 8 out of 11 patients) and mycobacterial culture turned negative in 10 out of 11. Conclusion: Promising results may be associated with early intervention with antimycobacterial therapy in CF patients.
Energy expenditure in infants with congenital heart disease, including a meta‐analysis
Authors: van der Kuip M , Hoos MB , Forget PP , Westerterp KR , Gemke RJBJ , Meer K de 
Published: August 2010

Aim: To assess energy requirements and body composition in preoperative children with congenital heart disease (CHD). Methods: In 11 infants with CHD (2–8 mo), total daily energy expenditure (TDEE) and total body water (TBW) were measured with doubly labelled water and compared with historic data from healthy controls. Within the patient group, energy expenditure of infants with versus those without congestive heart failure was compared. Subsequently, the data were pooled with literature data in meta‐analyses. Results: CHD patients showed increased TBW (mean ± SD 66 ± 3 vs 58 ± 5% of body weight, p < 0.05) and energy expenditure (381 ± 42 vs 298 ± 36 kJ kg‐1d‐1, p < 0.001). Meta‐analyses showed that CHD infants have 35% increased TDEE (376 vs 278 kJ kg‐1 d‐1, p < 0.00001) and 7% higher TBW (p < 0.0001). Coexistent congestive heart failure (treated with diuretics) had no influence on TDEE (mean difference 14 kJ kg‐1d‐1, not significant). In patients with heart failure and growth retardation, an energy balance study showed an average 12% loss of initially ingested energy due to vomiting, increased TDEE and low faecal energy loss, resulting in low energy available for growth, compared with controls (42 ± 30 vs 96 ± 61 kJ kg‐1 d‐1, p < 0.05). Conclusion: Many infants with CHD require substantially higher energy intake (at least 100 kJ kg‐1 d‐1 extra) owing to increased TDEE, which is not explained by a higher percentage of body water. Coexistent heart failure does not appear to have an additional influence on TDEE. In infants with CHD and growth failure factors other than elevated TDEE, including vomiting, may explain the disturbed energy balance.
Attention and memory training in children with acquired brain injuries
Authors: Hooft I van't , Andersson K , Sejersen T , Bartfai A , Wendt L von 
Published: August 2010

Aim: To test the feasibility of the Amsterdam memory and attention training for children (Amat‐c) in Swedish children with acquired brain damage. Methods: Amat‐c consists of structured exercises in specific attention and memory techniques. Three Swedish children aged 9–16 y with acquired brain injuries and related memory and attention deficits trained with the Amat‐c method for half an hour a day in school or at home interactively with a teacher or parent for a period of 20 wk. Results: All children and their coaches completed the training without interruption. The results showed an improvement in several neuropsychological tests of sustained and selective attention as well as in memory performance. Questionnaires filled in by parents and teachers indicate that, using the Amat‐c method, the children learned strategies that improved their school achievement and self‐image. Conclusions: The Amat‐c is a valuable treatment option for improving cognitive efficiency in children with acquired brain injuries. The results indicate improved performance in several psychometric measurements. On the basis of these results, the second step will be to modify the complexity and duration of the method, as well as to integrate a reward system before further evaluating the efficacy in a larger controlled study.
Correlates of breastfeeding duration in an urban cohort from Argentina
Authors: Berra S , Sabulsky J , Rajmil L , Passamonte R , Pronsato J , Butinof M 
Published: August 2010

Aim: To analyse factors associated with the duration of breastfeeding in a representative cohort of mothers and children, including socio‐demographic and cultural characteristics, breastfeeding antecedents, perinatal factors and perinatal healthcare practices. Methods: The study was conducted in the city of Cordoba, between 1993 and 1998. Mother‐child binomials from all public and private hospitals were asked to participate. Follow‐up consisted of home visits at 30 d, 6, 12, 24, 36, 48 and 50 mo. Information was obtained on 650 healthy newborns. Cessation of breastfeeding during the first 24 mo of life was analysed using the Kaplan‐Meier method, and factors associated with weaning were studied using Cox's proportional risk regression. Results. The median duration of breastfeeding was 4 mo. Factors associated with weaning were: the introduction of artificial formulas within 30 d postpartum [relative risk (RR) = 2.27; 95% confidence interval (CI) = 1.82–2.82]; breastfeeding of a previous child for less than 6 mo (RR=1.64; 95% CI = 1.32–2.02); delay in the first mother‐child contact for over 90 min (RR=1.50; 95% CI = 1.17–1.93); mother's having completed primary or partially completed secondary education (RR= 1.40; 95% CI = 1.01–1.92) or completed secondary education or higher (RR= 1.59; 95% CI = 1.14–2.22); primiparous mother (RR= 1.39; 95% CI = 1.12–1.74) and; the mother recalling having been breastfed for less than 6 mo (RR = 1.27; 95% CI = 1.01–1.61). Conclusions. The purpose of strategies to promote breastfeeding should be to eliminate inappropriate care practices, such as delay in the first mother‐child contact, as well as reducing the impact of other factors leading to the introduction of artificial milk. Moreover, mothers need more and better support from professionals and peers.