bluuebunny/crossref_metadata_2025_split huggingface dataset:
Supraventricular tachycardia: an incidental diagnosis in infants and difficult to prove in children
Authors: Vos P , Pulles‐Heintzberger CFM , Delhaas T 
Published: August 2010

Aims: To determine (a) the age distribution at first clinical supraventricular tachycardia (SVT) presentation; (b) the time interval between first clinical suspicion and electrocardiographic proof of SVT; c) the most indicative symptoms and signs of SVT; and (d) the SVT mechanism and its age distribution according to surface ECG.Methods: The records of 55 children (32 males and 23 females) with electrocardiographically proven SVT but without congenital heart disease were reviewed.Results: At diagnosis, 27 patients (49%) were younger than 1 y (infants), and 28 (51%) were older than 1 y (children). Only a quarter of infants presented with symptoms. The majority (20/27), however, were detected during routine investigation without having any complaints. Children presented with symptoms (mostly palpitations) in almost 90% of cases. Despite these symptoms, the median time interval between first clinical presentation suggestive of SVT and electrocardiographic proof of SVT was 138 d. Using surface ECG, we were unable to show any age‐dependency of the SVT mechanism in our study group.Conclusion: In infants SVT is a chance finding; SVT can only be proven electrocardiographically with a median delay of 138 d, despite the presence of symptoms; SVT using a (concealed) accessory pathway is the most common mechanism
Diaphragm dimensions of the healthy term infant
Authors: Rehan VK , McCool FD 
Published: August 2010

Aim: Human neonatal diaphragm development has not been extensively studied. Previous work in children and adults suggests that diaphragm thickness (tdi) is in scale with body size such that maximal transdiaphragmatic pressure (Pdimax) remains relatively constant. Such assessments have not been made in healthy term infants. This study was designed to evaluate the relationships among tdi, body dimensions and Pdimax healthy term infants. Methods: It was hypothesized that in healthy term infants 1) tdi is positively correlated with body size and 2) calculated Pdimax is independent of body weight and length. Fifteen clinically stable term infants (8 males and 7 females) were recruited [birthweight (BW), 3.3 ± 0.7 kg, (mean ± SD); head circumference (HC), 33.7 ± 2 cm; body length (BL) 50 ± 3 cm; gestational age (GA) 39 ± 1 wk; and postnatal age 1.7 ± 0.8 day]. Ultrasound was used to visualize the diaphragm at the level of the zone of apposition and measure tdi. Standard techniques were used to measure the anthropometric dimensions of the rib cage. Pdimax was calculated using the piston‐in‐cylinder model of diaphragm function. Results: Significant correlations were found among tdi and BW (R = 0.58), BL (R = 0.58) and HC (R = 0.65) but not between GA (R = 0.20). Larger infants tended to have thicker diaphragms and larger cross‐sectional areas of the lower rib cage (AZAP). For the group, calculated Pdimax was independent of either body weight or length and was greater than that calculated for adults. Conclusion: It is concluded that diaphragm mass in healthy term infants is proportional to body size, whereas calcuated Pdimax is independent of body size. Since calculated Pdimax is greater than that predicted for adults, there may be perinatal diaphragm strengthening. This may assist the infant in generating sufficient pressure to overcome the enormous elastic and resistive loads imposed during perinatal pulmonary transition.
Haemodynamic features during high‐frequency oscillatory ventilation in preterms
Authors: Cambonie G , Guillaumont S , Luc F , Vergnes C , Milesi C , Voisin M 
Published: August 2010

Aim: To compare the haemodynamic status during high‐frequency oscillatory ventilation and conventional mechanical ventilation in very preterm infants with respiratory distress syndrome. Methods: Thirty‐two neonates of less than 30 wk gestation randomly assigned to high‐frequency oscillatory ventilation (n= 15) or conventional mechanical ventilation (n= 17) had three echocardiographies and one cerebral Doppler‐echography under the same ventilation during the first 48 h of life. Results: Mean airway pressure was 2 cm H2O higher in infants ventilated with high‐frequency oscillatory ventilation at the different echocardiographies. Comparable right ventricular indexes were observed in the two groups. Reduction of the ductus arteriosus diameter and ductal closure were significant only in neonates ventilated conventionally. Left ventricular performance and left ventricular contractility did not differ between the groups. The high‐frequency group had lower end diastolic velocity and a higher resistance index in the anterior cerebral artery. Conclusion: Compared with conventional mechanical ventilation, high‐frequency oscillatory ventilation was achieved without altering cardiac function. However, the inability of the left ventricle to improve its performance in the presence of a significant ductal shunt suggests a narrow range of optimal pressures under this ventilatory mode.
Tolerance to early human milk feeding is not compromised by indomethacin in preterm infants with persistent ductus arteriosus
Authors: Bellander M , Ley D , Polberger S , Hellström‐Westas L 
Published: August 2010

Aim: Early human milk feeding is beneficial for gut and brain development. Persistent ductus arteriosus (PDA) and indomethacin may compromise enteral function in preterm infants. For many years enteral milk feedings have continued in preterm infants receiving indomethacin for PDA. The aim of this study was to investigate whether this strategy is efficient in terms of risks and tolerance to early enteral feeding. Methods: This retrospective study included 64 inborn infants of <29 wk gestational age (GA), 32 infants who received indomethacin for symptomatic PDA (case infants) and 32 matched controls. Case infants had a mean (SD) GA of 26.3 wk (1.3) and body weight 839 g (203) versus controls GA 26.4 wk (1.2) and body weight 896 g (213) (p= 0.82 and 0.27, respectively). Case infants had higher respiratory morbidity; 90.6% versus 50% of controls needed mechanical ventilation (p= 0.000). Results: Case infants received human milk from a median (range) age of 4.0 h (1.5‐27.5), and controls from 5.3 h (2.0‐38.0) (p= 0.092). The first dose of indomethacin was given at a mean age of 1.7 d (1.0). There were no differences between the two groups in feeding volumes or gastric residuals on days 1 to 7. Mean (SD) feeding volume on day 7 was 64 ml/kg (31) in case infants and 76 ml/kg (30) in controls (p= 0.23). Four infants developed necrotizing enterocolitis: two case infants and two controls (p= 1.00). Conclusion: Early enteral feeding with human milk, starting within the first hours of life, seems to be as well tolerated in preterm infants treated with indomethacin for PDA as in their matched controls.
Corticosteroid treatment in meconium aspiration syndrome: a solution for better outcome?
Authors: Kääpä P 
Published: August 2010

Corticosteroid treatment in severe meconium aspiration syndrome may afford, especially if started early, some improvement in oxygenation, lung function and pulmonary haemodynamics during the acute phase of the disorder. Still, the effects of corticosteroids on lung tissue perturbations and outcome of diseased infants remain unclear. Conclusion: Further research is needed to determine the clinical significance and optimal timing and dosing of corticosteroid treatment in severe meconium aspiration syndrome.
Alpha/beta intraepithelial lymphocytes, serum gliadin antibodies and allergy test positivity in children
Authors: Linkosalo L , Kaila M , Ashorn M , Turjanmaa K , Haapala A‐M , Karikoski R , Holm Kati 
Published: August 2010

Aim: To determine whether the amount of αβ‐positive intraepithelial lymphocytes (IELs) is connected to allergy test positivity in children with gastrointestinal symptoms and whether elevated serum gliadin antibodies have any role in the diagnosis. Methods: Twenty‐seven children suffering from gastrointestinal‐symptoms in whom intestinal biopsies had previously been obtained via endoscopy or with capsule biopsy to exclude coeliac disease were included into the study. The other inclusion criteria were increased amounts of CD3 and αβ‐positive IELs with normal amounts of γδ‐positive IELs in duodenal or jejunal biopsy specimens. At the control visit, the children underwent a physical examination and parents filled in a questionnaire concerning gastrointestinal‐and atopic symptoms. Skin prick‐ and patch tests were done and serum gliadin, endomysium, transglutaminase antibodies and specific IgEs were measured. Results: Only nine children (33%) had at least one positive result in the allergy tests, the rest remaining test negative. In children with digestive symptoms, IgG‐class gliadin antibody titres were higher than those of the non‐symptomatic children. A significant correlation was found between IgG‐class gliadin antibodies and total amount of αβ‐positive IELs (p= 0.017). Conclusion: No positive skin test or specific IgE positivity for cereals in children with high intestinal T‐cell densities was observed. The correlation between IgG‐class gliadin antibodies and the total amount of αβ‐TCR positive‐cells is likely to be a reflection of local immune response of the gut.
Children at risk in traffic: improvement potentials in the Swedish context
Authors: Hasselberg M , Laflamme L 
Published: August 2010

Aim: To investigate the social risk distribution and improvement potentials for road traffic injuries among Swedish children by considering three categories of road users. Methods: A population‐based cohort study of children aged 1–14 y was carried out. Subjects were taken from the Swedish Population and Housing Census of 1990 (n= 1 406405), and followed‐up in the National Hospital Discharge Register for the years 1991–1999 focusing on injuries incurred as pedestrians, bicyclists or car passengers (n= 16084). Household socio‐economic position was measured using social class, education and disposable income. Relative risks were calculated using Poisson regression for each measure of socio‐economic position and by combining them, adjusting for sex, age of child and age of mother at delivery. Population‐attributable risks were compiled for each category of road user and each measure of socio‐economic position. Results: Children of farmers and the self‐employed are at greater risk for injuries as car passengers (RR 2.40, CI 1.79–3.20 and RR 1.44, CI 1.16–1.79, respectively), but not for pedestrian‐ and bicycle‐related injuries. Children of unskilled workers are at greater risk for pedestrian injuries (RR 1.39, CI 1.15–1.67). Controlling for education and disposable income did not affect the relative risks to the same extent according to the social class and category of road user. The highest population‐attributable risks were related to family disposable income and were indicated for pedestrians and car passengers (19–20%). Conclusion: By taking children's limited ability to deal with different types of traffic situations into consideration, considerable improvements in children's risk levels have been observed. Now there is a need to add equity in the road traffic safety equation.
Diagnosis and treatment of a newborn with homozygous protein C deficiency
Authors: Salonvaara M , Kuismanen K , Mononen T , Riikonen P 
Published: August 2010

The case is reported of a seriously affected newborn with homozygous protein C deficiency who developed neonatal purpura fulminans. Foetal ultrasound at 33 wk of gestation revealed ventriculomegaly. The first lesions appeared on the scalp 48 h after birth. She was initially treated with fresh‐frozen plasma and, after the diagnosis was confirmed, with purified protein C concentrate. After skin necrosis had healed, therapy was continued with oral warfarin. The infant was homozygous for protein C W380G mutation. Diagnosis at the DNA level gave the parents an option of reliable prenatal diagnosis in their subsequent pregnancy. Conclusion: Difficulties in reaching an accurate diagnosis are discussed since early diagnosis and urgent therapy with protein C replacement are crucial to avoid further damage after delivery.
Changing incidence and outcome of infants with respiratory distress syndrome in the 1990s: a population‐based survey
Authors: Koivisto M , Marttila R , Kurkinen‐Räty M , Saarela T , Pokela M‐L , Jouppila P , Hallman M 
Published: August 2010

Aim: To evaluate the trends in the incidence, clinical course and outcome of respiratory distress syndrome (RDS) in the newborn in the Oulu University Hospital region in northern Finland. Methods: In the population of 58 990 infants, the incidence rates of RDS specific to gestational age and birthweight in two consecutive periods, 1990–95 and 1996–99, were calculated. Clinical course and other neonatal morbidities were reported. All surviving infants were followed up until 1 y of corrected age. Results: The overall incidence of RDS did not change significantly (8.7/1000 livebirths in 1990–95 vs 7.6 in 1996–99; p= 0.15), but the gestational age‐adjusted incidence decreased between the two consecutive periods (p= 0.005). The frequency of infants with gestational age below 28 wk tended to increase towards the late 1990s, while their RDS incidence remained unchanged. RDS‐related neonatal mortality decreased in parallel with neonatal mortality, accounting for 15% of all neonatal deaths. The duration of oxygen therapy shortened (8.0 vs 5.5 d) and the incidence of pneumothorax decreased (9.7 vs 4.1%), whereas the rate of chronic lung disease at 36 wk of postconceptional age (16.4 vs 16.7%) and at 1 y of corrected age (9.2 vs 8.2%) remained unchanged, as did also associated neurosensory morbidity (8.8 vs 9.5%). Conclusion: During the 1990s, the incidence of RDS shifted towards more immature infants and the gestational‐age specific incidence decreased. The course of the disease shortened and acute complications decreased. The frequency of chronic pulmonary sequelae (and associated neurosensory morbidity) at the age of 1 y did not change significantly.
Perinatal risk factors of adverse outcome in very preterm children: a role of initial treatment of respiratory insufficiency?
Authors: Hansen B Mølholm , Hoff B , Uldall P , Greisen G ,   the Danish ETFOL group
Published: August 2010

Aim: To investigate risk factors of adverse outcome in a cohort of very preterm children treated mainly with nasal continuous positive airway pressure (CPAP) during the neonatal course. Methods: In Denmark, preterm children are treated with nasal CPAP as a first approach to respiratory support. A national prospective study of all infants with a birthweight below 1000 g or a gestational age below 28 wk born in 1994–1995 was initiated to evaluate this approach. Of the 269 surviving children 164 (61%) were not treated with mechanical ventilation in the neonatal period. A follow‐up of the children at 5 y of age was conducted. Data from the neonatal period and the 5‐y follow‐up were analysed. Results: In multivariate analyses including 250 children, a severely abnormal neonatal brain ultrasound scan was predictive of cerebral palsy (OR= 19.9, CI 95%: 6.1–64.8) and intellectual disability (OR = 6.2, CI 95%: 2.3–16.5). A high Clinical Risk Index for Babies (CRIB) score (OR = 2.4, CI 95%: 1.1–5.5) and chronic lung disease (OR = 2.8, CI 95%: 1.2–6.9) were predictive of intellectual disability. In univariate analyses mechanical ventilation was associated with cerebral palsy (OR = 4.3, CI 95%: 1.7–10.8) and intellectual disability (OR = 2.2, CI 95%: 1.2–4.2), but the associations became insignificant in multivariate analyses including chronic lung disease and a severely abnormal ultrasound scan. Conclusion: The associations between neonatal risk factors and adverse outcome in our cohort were very similar to those found in other cohorts with another initial treatment of respiratory insufficiency. We found no significant adverse effects of mechanical ventilation beyond what could be explained by associations with chronic lung disease and IVH 3–4/PVL.
Neonatal accessory digits: a survey of practice amongst paediatricians and hand surgeons in the United Kingdom
Authors: Dodd JK , Jones PM , Chinn DJ , Potokar T , Laing H 
Published: August 2010

Aim: To describe the management of neonatal accessory digits, comparing views of paediatricians with those of hand surgeons, giving particular emphasis to the form of partial, ulnar duplication of the little finger (ulnar or postaxial polydactyly type B) which has a narrow pedicle. Methods: Postal questionnaire of management preference using three photographs of ulnar accessory digits of varying complexity. Results: The response rate was 64% in 234 paediatricians and 25% in 260 surgeons. All respondents would intervene in cases of ulnar polydactyly type B with a narrow pedicle; 79% of paediatricians but only 67% of hand surgeons would recommend referral of these cases for specialist assessment, the remainder advocating ligation by the paediatrician in the nursery. Paediatricians and neonatologists working in regional centres or with an on‐site specialist service were more likely to refer. There was almost unanimous agreement on the management of the most complex case, but no general consensus on that of the simplest form. Conclusion: There is uncertainty and inequality in initial treatment decisions for infants with all but the most complex of accessory digits. Despite published evidence that ligation gives satisfactory results, most respondents in this survey advocate specialist referral, with evidence that the availability of specialist services influences decision making.
Sudden infant death syndrome risk questionnaire: a mirror of parental awareness rather than a prospective diagnostic tool
Authors: Zotter H , Kerbl R , Schwantzer G , Kurz R , Einspieler C 
Published: August 2010

Aim: In 1989, a scoring system that aimed to identify infants at risk of sudden infant death syndrome (SIDS) by a structured questionnaire [SIDS risk questionnaire (SRQ)] consisting of 25 items was introduced in Styria (Austria). It was the aim of the study to compare SIDS rates in the population that had access to the SRQ with the population that had no access. Furthermore, for the population receiving the SRQ, the responding (compliant) and non‐responding (non‐compliant) groups were compared concerning the incidence of SIDS. Methods: Within the study period, 53 865 births and 57 SIDS cases were recorded (incidence 1.06/1000) and analysed retrospectively. Results: The incidence of SIDS was significantly higher in the non‐responding population (2.36/1000) than in the responding group (0.81/1000, p < 0.001). However, the incidence of SIDS was not significantly different in the population that had access to the risk questionnaire (1.29/1000) and the group without access (0.86/1000, p= 0.145). Conclusion: The value of any questionnaire used for SIDS prevention may be limited by the existence of a non‐compliant population which represents a risk group and should be targeted by other preventive measures.
Young people, HIV/AIDS/STIs and sexuality in South Africa: the gap between awareness and behaviour
Authors: James S , Reddy SP , Taylor M , Jinabhai CC 
Published: August 2010

Aim: To determine the baseline data of secondary school students in the Midlands district of Kwa‐Zulu, Natal, South Africa. The data provide details of students' knowledge about sexually transmitted infections (STIs) including HIV and AIDS, spread, prevention, how they can protect themselves from contracting an STI, their general awareness and sources of information, their perceptions of their vulnerability and their sexual practices. Methods: A cross‐sectional study was carried out among 1113 grade 11 students in 19 randomly allocated secondary schools. Data were collected through structured questionnaires and analysed using the SPSS software package. Results: The results confirm that knowledge levels were high for causes and spread of STIs and the participants were well informed about issues relating to protection against STIs and seeking treatment. However, there was significant deviation in reported behaviours. Conclusion: This discrepancy between awareness and behaviour calls for a reorientation of sexuality education to include those elements critical for behavioural change, such as addressing gender discrepancies and promoting skills for communication through planned intervention programmes.
Snakebites in children in the densely populated city of Hong Kong: a 10‐year survey
Authors: Hon KL , Kwok LW , Leung TF 
Published: August 2010

Aim: To review the pattern and characteristics of snakebites in children in rural Hong Kong. Methods: A retrospective chart review was conducted. Results: Seven cases of snakebite in children were reported. Eighty‐six percent of the victims were male, and the majority of bites (86%) occurred on the left extremities. Green pit vipers (Trimeresurus albolabris) accounted for most of the snakebites. Local symptomatology was common. Swelling, pain and fang marks were documented in all cases. A mildly deranged clotting profile was found in 70% of patients. There was no incidence of systemic symptoms, cardiopulmonary complications or compartment syndrome. Victims arrived at the hospital at a median (range) time of 40 (10–70) min since the snakebite. Only one child received antivenin owing to severe progressive local symptoms under intensive care monitoring. The median hospital stay of the patients was 4 d. The hands and feet of adolescent boys (n= 6) seem to be particularly prone to being bitten. Conclusion: Children should be discouraged to play in areas where snakes may hide, especially in the evening in summer to autumn. They should wear protective footwear.
Altered regional blood flow in the fetus: the origins of cardiovascular disease?
Authors: Barker DJP , Hanson MA 
Published: August 2010

A fetal response to hypoxia and other adverse influences is to redistribute blood flow in order to “spare” the brain. This, however, is associated with reduced growth of the liver and kidneys. Conclusion: The long‐term consequences of fetal redistribution of blood flow are unknown, but preliminary evidence suggests that there is an increased risk of coronary heart disease and hypertension in later life.