bluuebunny/crossref_metadata_2025_split huggingface dataset:
False alarms in very low birthweight infants: comparison between three intensive care monitoring systems
Authors: Ahlborn V , Bohnhorst B , Peter CS , Poets CF 
Published: August 2010

Monitor alarms are a major burden on both patients and staff in intensive care units. We compared alarm rates from three different monitor systems (Hewlett Packard (HP), Kontron Instruments (KI), Marquette‐Hellige (MH)) in a tertiary neonatal intensive care unit. Monitors were used in random order on three consecutive days over 8h each in 16 preterm infants (median gestational age at birth 29 wk (range 24‐34), age at study 18 d (8‐53), weight at study 1160g (595‐1430)). Alarms were classified as true or false using flow sheets based on continuous observation of both the patient and related parameters. There was one alarm every 9 min of monitoring. The median number of true alarms did not differ significantly between systems, being 28 per 8 h (range 9‐87) for HP, 26 (3‐81) for KI, and 30 (5‐135) for MH. The median number of false alarms differed widely, with the HP system generating 32 (7‐77) such alarms per 8 h, compared to 8 (0‐19) for KI and 15 (2‐32) for MH (p < 0.01 HP vs KI and MH, p lt; 0.05 KI vs MH). These differences between systems were mainly due to differences in pulse oximeter and transcutaneous PO2 monitor alarm rates.Conclusions: In conclusion, this study shows marked differences between both parameters and manufacturers in the frequency with which false alarms occur. It may provide a basis from which reductions in alarm rates can be sought.
Population‐based body mass index reference values from Göteborg, Sweden: birth to 18 years of age
Authors: He Q , Albertsson‐Wikland K , Karlberg J 
Published: August 2010

The body mass index or BMI (weight/height2) is a somewhat crude estimate of nutritional status. However, due to its simplicity and high correlation with total body fat, it has been the method of choice in both paediatric clinics and research over the years. Since BMI is not an equivalent measure of the percentage of body fat in different ethnic groups and in the two sexes, population‐specific BMI reference data is needed. Several BMI reference values have been published for French, American, British and Hong Kong children in recent years. In Sweden, weight‐for‐age and height‐for‐age reference values, which were published in 1976, are still used as the current national growth reference values. Updated growth reference values are needed for assessing nutritional status due to the secular trend toward and increasing prevalence of childhood obesity. The aim of this study was to produce BMI reference values for Swedish children of paediatric age. The series came from a large Swedish population‐based longitudinal growth study of 3650 full‐term babies followed from birth to 18 y of age. The children in this data set were born in the early 1970s. The pattern and level of 50th centile BMI values presented here are quite similar to those of the Swedish cohort study in the 1950s. In comparison with the US BMI reference values, the Swedish values are much lower, especially for the higher centile values.Conclusion:The new Swedish BMI chart from our study may provide a useful tool for paediatricians to assess body fat, and consequently nutritional status, in Swedish children.
Can parents predict the severity of childhood obstructive sleep apnoea?
Authors: Preutthipan A , Chantarojanasiri T , Suwanjutha S , Udomsubpayakul U 
Published: August 2010

Objective: To determine whether parents' observations can be used to predict the severity of the obstructive sleep apnoea syndrome (OSAS) in children. Study design: Sixty‐five children with OSAS diagnosed by overnight polysomnography were consecutively recruited and classified as having severe or non‐severe OSAS according to the obstructive apnoea index (OAI) and the oxygen saturation measured by pulse oximetry (SpO2) nadir. Parents were asked to complete a questionnaire about the child's breathing difficulties at night. Results: Twenty‐eight patients were classified as severe OSAS and 37 as non‐severe OSAS. There were no differences between the two groups with respect to age, sex or body mass index. Male to female ratio was 5:1. Parents of children with severe OSAS more frequently reported observed cyanosis (35 vs 8%; p= 0.02); obstructive apnoea (60 vs 35%; p = 0.04); snoring extremely loudly (52 vs 22%; p = 0.01); shaking the child (64 vs 35%; p = 0.02); watching the child during sleep and being afraid of apnoea (85 vs 60%; p = 0.03). However, neither any single nor combinations of observations showed high values for both sensitivity and specificity.Conclusions: Although some parents' observations are more frequently reported in children with severe OSAS, neither any single nor combinations of observations accurately predict the severity of OSAS. Polysomnography is still needed to determine the severity of obstruction.
Investigation and outcome of neonatal hepatitis in infants with hypopituitarism
Authors: Spray CH , McKiernan P , Waldron KE , Shaw N , Kirk J , Kelly DA 
Published: August 2010

Congenital hypopituitarism is a recognized cause of neonatal hepatitis, but the diagnosis may be difficult to establish even if clinically suspected. In order to determine the natural history of this disorder, the outcome of 12 infants with neonatal hepatitis secondary to hypopituitarism is reviewed. The clinical diagnosis of hypopituitarism was established on a combination of features, which include dysmorphism (4 infants), optic nerve hypoplasia (8 infants), micropenis (5 male infants) and recurrent hypoglycaemia (blood glucose < 2.4 mmol/l (8 infants)). Endocrine investigation revealed low free thyroxine (T4) levels (<10 pmol/l), with normal thyroid stimulating hormone (TSH) levels (0.4‐4.5 mU/l) (11 infants), and serum cortisol levels which were inappropriately low (< 200 nmol/l). In 9 of 12 infants, liver disease resolved within 6 wk following treatment with thyroxine, hydrocortisone and, where appropriate, growth hormone, including Cases 9 and 1 in whom diagnosis and treatment were delayed until 3 mo and 3 y of age, respectively. Liver disease resolved spontaneously in two infants prior to starting hormone replacement therapy (Cases 11, 12), and one male infant (Case 10), in whom the diagnosis and hormone replacement therapy were delayed until 5 y of age, developed cirrhosis and portal hypertension and later underwent liver transplantation. Conclusion: The diagnosis of hypopituitarism should always be considered in infants with unexplained neonatal hepatitis. Delay in diagnosis and appropriate treatment was associated with persistently abnormal liver function tests and may lead to irreversible liver disease.
Thymus size and its relationship to perinatal events
Authors: Chen C‐M , Yu K‐Y , Lin H‐C , Yeh G‐C , Hsu H‐H 
Published: August 2010

A retrospective study was conducted to assess radiographically the thymus size in well and sick neonates and to search for a possible relationship to perinatal events. Thymus size was expressed as cardiothymic:thoracic ratio (CT/T) by measuring the width of the cardiothymic shadow at the level of carina and dividing it by the width of the thorax at the costophrenic angles. The CT/T was measured on chest radiographs obtained on day 1 in well term neonates consecutively born in our nursery and sick neonates with meconium staining of the amniotic fluid, meconium aspiration syndrome or respiratory distress syndrome (RDS). Neonates with congenital anomalies, congenital heart disease or intrauterine growth retardation were excluded. There were no significant relationships between CT/T and sex, birth route, birthweight or gestational age in well and sick term neonates. The CT/T were comparable among well and sick term neonates and were significantly greater in the preterm neonates with RDS than in the preterm neonates without RDS. The CT/T was correlated to the birth route only in the preterm neonates.We conclude that thymus involution in the perinatal period is a complex process and the response is different between term and preterm neonates.
Effects of back care education in elementary schoolchildren
Authors: Cardon G , De Clercq D , De Bourdeaudhuij I 
Published: August 2010

The purpose of this study was to investigate the effects of a back care education programme, consisting of six sessions of 1 h each, in fourth‐ and fifth‐grade elementary schoolchildren. Testing consisted of a practical performance and a back care knowledge test. Forty‐two subjects and 36 controls performed a pre‐test and were tested within 1 wk after the programme. To monitor effects and follow‐up effects on a larger sample, 82 different pupils were tested within 1 wk after the programme and 116 other children 3 mo after. Both larger samples were compared with one group of 129 controls. Interrater reliability for the test items of the practical assessment was high; intraclass correlation coefficients varied from 0.785 to 0.980. In the pre/post design study, interaction between time and condition was significant for the sum score of the practical assessment and for the knowledge test (p < 0.001), with higher scores for the intervention group (15% improvement for the knowledge test score, 31.6% for the practical sum score). Significantly higher sum scores for the knowledge test and for all practical assessment items were found in the intervention groups, tested within 1 wk and 3 mo after the programme, in comparison with the control group (p <0.001). Conclusion: The effectiveness of a primary educational prevention programme on back care principles was demonstrated in this study. Effectiveness, long‐term outcomes and behavioural changes need further evaluation to optimize back care prevention programmes for elementary schoolchildren.
Lupus anticoagulant and protein S deficiency in otherwise healthy children with acute varicella infection
Authors: Kurugöl Z , Vardar F , Özkinay F , Kavakh K , Özkinay C 
Published: August 2010

Acquired protein S deficiency and lupus anticoagulant have been described in children with varicella who had purpura fulminans, disseminated intravascular coagulation or thrombosis. The aim of this study was to investigate the natural anticoagulants, hypercoagulability markers, other parameters of coagulation and fibrinolytic systems, and the presence of the lupus anticoagulant in otherwise healthy children with acute varicella infection. Blood samples were obtained from 17 children with varicella without thrombosis during acute varicella infection and 1 mo after onset. Coagulation tests included determinations of the prothrombin time, the activated partial thromboplastin time, the thrombin time, the thrombin antithrombin complex, the prothrombin fragment F 1 + 2, the tissue plasminogen activator, the plasminogen activator inhibitor‐1, protein C activity and free protein S antigen. Antiphospholipid antibodies were determined in enzyme‐linked immunosorbent assays. The mean free protein S concentration in the acute phase (0.63 ±0.16U/ml) was significantly lower than that of the concentration determined 1 mo later (0.82 ± 0.17 U/ml). The children with acquired free protein S deficiency also had a lupus anticoagulant. Elevated concentrations of the prothrombin fragment F 1+2, the thrombin antithrombin complex, D‐Dimer, tissue plasminogen activator and plasminogen activator inhibitor‐1 were detected in most of the children. Conclusion: There is a significantly increased prevalence of lupus anticoagulant, a significantly reduced plasma concentration of free protein S and elevations in coagulation and fibrinolytic parameters in otherwise healthy children with acute varicella infection.
Non‐nutritive sucking by infants exposed to pethidine in utero
Authors: Hafström M , Kjellmer I 
Published: August 2010

Obstetric analgesia in the form of pethidine (meperidine) to mothers during delivery has adverse effects on some aspects of the behaviour of their newborn infants. The non‐nutritive sucking (NNS) pattern of nine healthy full‐term infants exposed to pethidine in utero was compared to that of a control group of infants. The pattern was analysed and quantified using an automatic computer‐based method. The results are discussed in the context of endogenous and exogenous opiates and their effect on brain‐stem rhythm generators.Conclusions: The typical NNS pattern with alternating sucking activity (bursts) and pauses is preserved in the exposed infants. There is a significantly lower sucking frequency (md 1.74 vs 1.90 Hz, p= 0.030*) and a tendency to a less stable rhythm in pethidine‐exposed infants.
Childhood injuries in the European Union: Can epidemiology contribute to their control?
Authors: Petridou E 
Published: August 2010

An average of 6000 children (0–14‐y‐old) died every year from injuries in the European Union during the last decade. Although the trends are overall favorable, injuries continue to represent the leading cause of death in this age group. The aim of this paper is to present childhood‐injury‐related public health issues and consider possible remedies of contemporary epidemiologic methods as applied to injury epidemiology and prevention. It has been estimated that half of the lives lost to childhood injuries could have been saved if all European Union countries matched the accomplishments of the country with the lowest mortality rate in each injury category. There is no specific pattern of association between Gross Domestic Product and incidence of motor‐vehicle accidents by category of road user, whereas fatality from motor‐vehicle accidents seems to be inversely, strongly and significantly related to Gross Domestic Product. Conclusion: The ongoing development of large injury databases in the European Union is a prerequisite for understanding the complex interactions that lead to a childhood injury. Moreover, possible remedies for overcoming the genuine problems associated with the application of traditional epidemiologic methods to the investigation of the frequently transient in nature causes of injuries should be considered.
Spontaneous growth in German children and adolescents with genetically confirmed Prader‐Willi syndrome
Authors: Hauffa BP , Schlippe G , Roos M , Gillessen‐Kaesbach G , Gasser T 
Published: August 2010

Height and weight in children with Prader‐Willi syndrome, diagnosed by standard clinical criteria, follow a specific developmental pattern resulting in early childhood obesity, absent pubertal growth spurt and adolescent short stature. New molecular techniques (methylation analysis, fluorescence in situ hybridization) now allow the unequivocal diagnosis of Prader‐Willi syndrome (PWS). We investigated the possibility of a bias in syndrome‐specific growth standards based on clinically diagnosed patients by comparing these standards with new standards derived from 100 German patients with molecularly confirmed PWS, none of whom had received a growth‐promoting therapy. Height centile curves of the German patients fall in the tall range of standards derived from American patients. This is mainly due to an elevation of the lower centile ranges in both sexes. When the height standards derived from German patients are compared to those of a large multinational cohort of patients, 78% of whom were not confirmed by genetic testing, only minor differences in the height centiles become apparent. The population background therefore does not appear to play a major role for the observed differences. In a marked proportion of patients a decreased sitting height/height ratio is found. This was usually associated with scoliosis. Weight standards from our study group show that after 14 y of age German girls with PWS are heavier than their American counterparts. Standards for the body mass index of German patients of both sexes are increased over normal reference standards (p <0.0001) and do increase with age (boys: p = 0.0038; girls: p = 0.0004). PWS genotypes or sex had no apparent influence on SDS for height, weight and body mass index. Conclusions: Because of the observed differences to other growth standards, use of the newly constructed centile curves is advocated in German patients with molecularly confirmed PWS to avoid delay in the diagnosis of additional growth‐compromising conditions.
Potential role of colour‐Doppler cystosonography with echocontrast in the screening and follow‐up of vesicoureteral reflux
Authors: Ascenti G , Chimenz R , Zimbaro G , Mazziotti S , Scribano E , Fede C , Ricca M 
Published: August 2010

Primary vesicoureteral reflux is a predisposing factor for urinary tract infections in children. The first‐choice technique for the diagnosis of vesicoureteral reflux is voiding cystourethrography, followed by cystoscintigraphy; cystoscintigraphy, however, has the advantage of only minor irradiation of the patient, but it does not allow the morphological evaluation of bladder and vesicoureteral reflux grading. Colour‐Doppler cystosonography with echocontrast is a recently introduced method for imaging vesicoureteral reflux. The aim of our study is to evaluate the role of colour‐Doppler cystosonography with echocontrast in the diagnosis of vesicoureteral reflux. Twenty children (11M, 9F) aged between 0.4 and 4.9 y underwent colour‐Doppler cystosonography using a diluted solution of Levovist® (Schering, Germany), after filling up the bladder with saline. In all patients, vesicoureteral reflux diagnosis and grading had been performed previously by voiding cystourethrography within 5 d from ultrasonography. Our data showed high accuracy in the detection of medium to severe vesicoureteral reflux (grades III‐V), confirmed by radiological features in 9/9 patients. Conversely, in the 11 patients with mild vesicoureteral reflux (grades I‐II), this technique showed extremely low sensitivity, allowing diagnosis in only four cases.Conclusions: Colour‐Doppler cystosonography, because of the absence of ionizing radiations, has great advantages, particularly in patients needing prolonged monitoring. Despite experiences reported in the literature, this technique has a role in the diagnosis of vesicoureteral reflux. Our group chooses colour‐Doppler cystosonography for the follow‐up of medium‐severe grade vesicoureteral reflux already diagnosed by radiology and/or scintigraphy. Cystoscintigraphy is employed only to confirm cases resulting negative at ultrasonography.
Central apnoea and endogenous prostaglandins in neonates
Authors: Hoch B , Bernhard M 
Published: August 2010

Aim: Central apnoeas without an identifiable precipitating cause frequently occur in the neonatal period. Serious apnoeas should be treated with ventilation‐enhancing methylxanthines. Drugs such as opioids or prostaglandins (PGE2) are known to induce apnoea. PGE2 is an endogenous hormone that plays an important role in the regulation of neural activity and a relationship between PGE2 and central apnoeas has been postulated. Methods: In order to test the hypothesis that the incidence of central apnoeas in preterm infants is related to endogenous PGE concentration, we measured the urinary concentration of PGE2 and PGE‐M and determined the number of central apnoeas >10s/12h in overnight polygraphy in 18 preterm infants with apnoeas, bradycardias and desaturations, and 18 normal controls. Results: We found 80.6 (SE 6.9) central apnoeas in the study group, and 52.9 (SE 4.1) in the control group (p= 0.002). Urinary PGE2 concentration was 25.9 (SE 6.1)ng/h/1.73m2 in the control, 31.2 (SE 15.8) ng/h/1.73m2 in the study group (p= n.s.), PGE‐M concentration was 486 (SE 35) ng/h/1.73m2 in the control and 1132 (SE 131) ng/h/1.73m2 in the study group (p < 0.0001). There was a significant correlation between the number of central apnoeas and the PGE‐M concentration in the study group (r= 0.68, p < 0.0001). Conclusion: Our results suggest a relationship between PGE and the respiratory system and open potential therapeutic options for the treatment of central apnoeas in neonates.
Epidemiology of invasive pneumococcal infections in children aged 0–6 years in Denmark: a 19‐year nationwide surveillance study
Authors: Kaltoft MS , Zeuthen N , Konradsen HB 
Published: August 2010

The impact of the new pneumococcal conjugate vaccines on invasive disease burden in Danish children was evaluated by analysing the results from the last 19 years of a nationwide surveillance of invasive pneumococcal infections. During 1981–1999, the Streptococcus Unit at Statens Serum Institut, Copenhagen, received 1123 invasive pneumococcal isolates from children aged 0–6 years. Nearly 72% (71.8%) of the pneumococcal isolates were from children aged <2 y. The median ages of children with pneumococcal meningitis and bacteraemia were 10.2 mo and 15.9 mo, respectively. The incidence of pneumococcal meningitis remained stable during the study period. The mean annual incidence rates of pneumococcal meningitis among children aged <1, <2, and <7 years were 17.4, 12.4, and 4.3 per 100000, respectively, during 1981–1999 (overlapping age groups are used throughout this article to facilitate the comparison of incidence data from different countries or among different studies). The annual incidence of pneumococcal bacteraemia increased from 1981 to 1996, after which a slight fall was noted. During the last six years of the study period, the mean annual incidence rates of bacteraemia were 30.1, 32.5, and 14.0 per 100000 children aged <1, <2, and <7 years. In the 1990s, pneumococcal isolates with reduced sensitivity to penicillin (0–5% each year) and erythromycin (7.4% in 1999) emerged as a cause of invasive infections in children aged 0–6 years in Denmark. During 1981–1999, 10 serotypes (1, 4, 6A, 6B, 7F, 9V, 14, 18C, 19F, 23F) caused 82% of invasive infections in Danish children. Importantly, no significant temporal changes in overall serotype distribution or differences in serotype distributions between girls and boys could be documented during the study period. Conclusion: According to the Kaiser Permanente trial, the 7‐, 9‐, and 11‐valent pneumococcal conjugate vaccines will probably cover around 60%, 70%, and 80%, respectively, of all invasive pneumococcal infections in Danish children aged 0–6 y, corresponding to 12–14 episodes of meningitis and 40–60 episodes of bacteraemia per year.
Epidemiology of pneumococcal disease in children in Germany
Authors: Ziebold C , von Kries R , Siedler A , Schmitt HJ 
Published: August 2010

Recently published and as yet unpublished data allow a reasonable estimate of the annual burden of pneumococcal disease in Germany. At least 277000 episodes of otitis media and at least 2000 episodes of sinusitis occur in children under the age of 5 y. Pneumococcal meningitis was found in 200 children under the age of 16 y; the estimate for all age groups ranges from 450 to 1100 cases. Of approximately 150000 cases of ambulatory pneumococcal pneumonia, at least 63 000–105000 patients are hospitalized each year. Conclusion: Further studies of pneumococcal epidemiology in Germany are needed, and continued surveillance will be necessary for a better understanding of the overall burden of pneumococcal disease in children as well as adults.