bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical course and determination of brainstem death in a children's hospital
Authors: Goh AY‐T , Mok Q 
Published: August 2010

Aim: To study the aetiology and clinical course of children with brainstem death in a paediatric intensive care unit (ICU) and to determine whether current the practices that are used to declare brainstem death conform to accepted criteria. Methods: A retrospective review chart of all patients with brainstem death (n= 31) admitted to the paediatric ICU between January 1995 and December 1998 was drawn up. Results: Mean age of the patients was 51.9 ± 54.5 mo with the main diagnoses being head trauma in 11 children, anoxic encephalopathy in 7, brain tumour in 5, drowning in 4, CNS haemorrhage in 3 and CNS infection in 1 child; 32.3% of the children were given pre‐ICU admission cardiopulmonary resuscitation. The average time from insult to suspected brainstem death was 27 h and suspected brainstem death to confirmation was 25 h, with an average of 1.6 examinations performed. EEG was done in 14 patients, with electrocerebral silence in 8 after the first examination and in a further 5 after repeat testing. Cerebral blood‐flow scans were done in 3 children and evoked potentials in 1 child. Conclusions: Trauma remains the most common primary diagnosis leading to brainstem death. Intensivists in this large hospital for children mainly conform to accepted guidelines for determination of brainstem death although there is a wider use of ancillary tests to aid diagnosis. The study also showed a low rate of < 10% of organ procurement for transplantation.
Refining the Apgar score cut‐off point for newborns at risk
Authors: Chong DSY , Karlberg J 
Published: August 2010

Aim: To evaluate the Apgar score predictive power for mortality during different periods in the first year of life in a population with a very low mortality rate. Methods: The records of all singleton live births without severe congenital malformations and length of gestation >25 wk (n= 976635) were collected from the Swedish Medical Birth Registry, 1990 to 1998. Receiver operating characteristic (ROC) analysis was utilized. Results: Both the 1‐min and the 5‐min Apgar scores were shown to be good discriminators for early mortality, with the area under the ROC curve >0.85. For babies at risk of early death, the selected cut‐off values for the 1‐min Apgar score was >8 for preterm (true‐positive (TP) rate: 83.9%; false‐positive (FP) rate: 17.7%) and term babies (TP rate: 69.4%; FP rate: 6.7%). At 5 min, the analysis revealed that newborns with an Apgar score >9 were at risk for early death (preterm babies: TP rate: 79.8%; FP rate: 13.3%; term babies: TP rate: 73.8%; FP rate: 3.4%). Conclusions: Our analysis did not support the common practice in the clinic or in research of grouping infants at risk in Apgar score groups, i.e. a score below 4 or a score below 7. However, the data presented here allow the clinicians and researchers to identify and define a suitable cutoff point in relation to the quality of neonatal care and resources available, rather than adhering to a historical cut‐off value that has not been studied in depth.
The natural history of idiopathic toe‐walking: a long‐term follow‐up of fourteen conservatively treated children
Authors: Hirsch G , Wagner B 
Published: August 2010

Aim: To determine the long‐term results after conservative treatment (physiotherapy, casting, orthoses, or a combination of these) of idiopathic toe‐walking (ITW). Methods: Tiptoe‐walking is diagnosed as idiopathic (habitual) if no signs of neurological, orthopaedic, or psychiatric disease are detected. The diagnosis is one of exclusion. Sixteen former patients with ITW, all now at least 13 y old, were asked to participate in a follow‐up investigation 7–21 y after being first diagnosed. Two cases were excluded because heel‐cord lengthening had been performed later on in other hospitals. The remaining 14 patients completed a questionnaire. Eleven patients consented to a clinical examination, during which they were videotaped and their active and passive ankle‐joint dorsiflexion measured. These data were compared with the assessment at the initial evaluation. In one instance, the toe‐walking ceased after conservative treatment (plaster cast). In all other cases the toe‐walking pattern recurred. Results: At follow‐up three patients showed some toe‐walking when they were unobtrusively observed. When videotaped, they did not toe‐walk, although a distinct heel‐strike was missing. The remaining eight patients all walked with a heel‐strike. Two patients had slight symptoms possibly related to toe‐walking. No fixed contracture was present at the first evaluation, and none was found at follow‐up. There was no systematic change in ankle‐joint dorsiflexion from initial assessment to follow‐up examination. Conclusion: Non‐surgical treatment of ITW does not have a lasting effect and the long‐term results in this study are considered to reflect the natural history, i.e. the toe‐walking pattern eventually resolves spontaneously in the majority of children. Surgical treatment of ITW should be reserved for the few cases with a fixed ankle‐joint contracture.
Enhanced local immune response in children with prolonged gastrointestinal symptoms
Authors: Kokkonen J , Holm K , Karttunen TJ , Mäki M 
Published: August 2010

Aim: Recently, we reported typical endoscopic findings and an increment in γδ+ T cells in the foregut among children with food‐sensitive enteropathy other than coeliac disease. To find out the extend to which the upregulation of the local immune response might explain gastrointestinal (GI) complaints of the foregut, we sought to examine by the increment in γδ+ T cells a 1‐y consecutive series of children referred for recurrent GI complaints to a tertiary‐level hospital. Methods: A 1‐y cohort of 102 children scheduled for gastroduodenoscopy were examined for mucosal histology and the densities of CD3+, αβ+ and γδ+ T‐cell subsets from mid‐duodenal specimens. The final diagnostic categories were used in analysing the data. Results: Fifteen subjects showed villous atrophy and a high γδ+ T‐cell density; the finding being compatible with coeliac disease (CD). At the other extreme, 20 subjects in whom diagnostic GI diseases were ruled out showed low densities and served as controls. The subjects reporting GI symptoms after an open food challenge with milk and/or cereals (n= 18) as well as children remitting with a milk‐ or cereal‐eliminating diet but not responding to a challenge (n= 23) also expressed significantly higher densities of γδ+ T cells than the controls. In all, 45 of 102 children could be considered to have an elevated γδ+ T‐cell density as an indication of locally activated immune response. Lack of villous architecture and lymphonodular hyperplasia of the duodenal bulb as an endoscopic finding and atopic dermatitis but not the presence of DQ2 alleles showed a close association with these increased densities. Conclusion: Considering that an elevated incidence of γδ+ T cells is an indication of mucosal response against luminal antigens, up to half the children with prolonged GI symptoms have immune mediated disorder; CD and food allergy being the most obvious clinical entities.
Continuous measurement of cerebral blood volume and oxygenation during rewarming of neonates
Authors: Naulaers G , Cossey V , Morren G , Van Huffel S , Casaer P , Devlieger H 
Published: August 2010

Aim: To investigate the effect of rewarming in preterm infants presenting with hypothermia at admission. Methods: The tissue oxygenation index (TOI), changes in cerebral blood volume (ACBV) and changes in intravascular oxygenation (AHbD) were measured in eight preterm infants, presenting with a temperature less than 35°C at admission. Results: A significant increase in HbD and TOI was seen in four patients (group A), while a significant increase in CBV and a decrease in HbD was seen in four other patients (group B). Retrospective analysis showed that group A had important signs of peripartal asphyxia. Conclusion: While infants with peripartal asphyxia showed an important increase in oxygenation during rewarming, no significant changes were seen in the non‐asphyxiated infants.
Cardiac troponin T levels and myocardial involvement in children with severe respiratory syncytial virus lung disease
Authors: Eisenhut M , Sidaras D , Johnson R , Newland P , Thorburn K 
Published: August 2010

Aims: To determine the prevalence of myocardial damage in severe respiratory syncytial virus (RSV) disease as evident from elevated cardiac Troponin T (cTnT) levels. To assess the nature of the myocardial involvement as manifested in electro‐and echocardiographic abnormalities. To compare severity of disease with and without myocardial involvement as evident from duration of ventilation, inotrope requirements and death. Methods: This was a prospective observational cohort study of children with RSV infection admitted to the paediatric intensive care unit at the Royal Liverpool Children's Hospital during the winter season 2002/2003. cTnT concentrations were measured using a third generation monoclonal sandwich immunoassay (Roche Diagnostics). Results: 34 children were included in our study. 12 (35%) had elevated cTnT levels. The levels measured after admission had a median [interquartile range (IQR)] of 50 pg/ml (37.5–67.5). There was no significant difference (p > 0.05) between patients with and without elevated cTnT levels with regards to gender, gestational age at birth, history of neonatal intensive care, presence of congenital heart disease, chronic lung disease, inotrope requirements, duration of ventilation, death, fractional shortening on echocardiogram or arrhythmias. Children with elevated cTnT levels were significantly younger [median (IQR): 1.4 months (0.8–2.0)] than children without [median (IQR): 4.0 months (1.7–6.6)] (p= 0.04). The systolic blood pressure on admission was lower in children with increased cTnT compared to those with undetectable cTnT (p= 0.01). Conclusions: Myocardial involvement is common in infants with severe RSV lung disease without congenital heart disease. cTnT level elevation was associated with hypotension.
Pain: a common symptom in human immunodeficiency virus‐infected Thai children
Authors: Lolekha R , Chanthavanich P , Limkittikul K , Luangxay K , Chotpitayasunodh T , Newman CJ 
Published: August 2010

Aim: To determine the prevalence and characteristics of pain in Thai human immunodeficiency virus‐infected children. Methods: A cross‐sectional study was performed at the HIV/AIDS outpatient clinic at the Queen Sirikit National Institute of Child Health, Bangkok, Thailand from November 2002 to January 2003. Sixty‐one human immunodeficiency virus‐infected patients aged 4 to 15 y, an equal number of age‐matched children with no chronic disease and their caregivers participated. We interviewed children and their caregivers using a structured questionnaire on pain. The main outcome measure was the percentage of human immunodeficiency virus‐infected children reporting pain. Results: Forty‐four percent of the human immunodeficiency virus‐infected children reported pain compared to 13% of the children with no chronic disease (odds ratio, OR = 5.3; 95% CI: 2.0–14.3). Seven percent of the infected children experienced chronic pain. Children in human immunodeficiency virus clinical categories B and C reported more pain than children in categories N and A (OR = 4.0, 95% CI: 1.1–14.7). Pain in infected children tended to occur in the abdomen, lower limbs or head. Only 44 percent of the infected children experiencing pain received analgesic medication. Conclusion: Despite being a common experience, pain is insufficiently taken into account and treated in Thai children with HIV/AIDS. Therefore, adequate pain identification, assessment and management should be systemically considered in their routine care.
The rate of candidaemia in preterm infants born at a gestational age of 23–28 weeks is inversely correlated to gestational age
Authors: Johnsson H , Ewald U 
Published: August 2010

Aim: To assess the rate of candidaemia and the associated case fatality rate in relation to gestational age, and the variation in the rate of candidaemia over time in the neonatal period. Methods: Retrospective review of medical records of infants with a positive blood culture for fungi while in the neonatal unit, Uppsala University Children's Hospital or at autopsy following death in the unit from 1994 to 2001 (n= 30). Results: The number of cases per year was found to vary between zero and eight. The annual rate of infection did not change significantly during the study period. The preterm infants with candidaemia (n= 29) were born at a gestational age ranging from 23–28 wk. The rate of candidaemia in this group was inversely related to gestational age and varied from 2 to 24%. Five infants (17%) died from Candida infection. Of these five, four were born at a gestational age of 23 wk. Conclusion: candidaemia in newborns occurs predominately in infants born at a gestational age ±28 wk, where the rate of infection is inversely correlated to gestational age in infants born at a gestational age of 23–28 wk. The highest case fatality rate is observed in infants born at a gestational age of 23 wk.
Behavioural and learning problems in schoolchildren related to cognitive test data
Authors: Ek U , Holmberg K , de Geer L , Swärd C , Fernell E 
Published: August 2010

Aim: To assess cognitive functions in children who were reported by their teachers and parents to exhibit learning and/or behavioural problems, especially in the field of attention. Method: In connection with the scheduled school health examination in grade 4 in one municipality, 591 children were screened through questionnaires and interviews with the parents and teachers. Those with positive rating scores were subjected to further cognitive assessments, including the WISC III. A cluster analysis based on cognitive data was performed. Results: One third (175 children) of the population obtained a positive rating score, indicating significant behavioural and/or learning problems. Of these, 144 children were assessed. Cluster analysis revealed six clusters. Within these clusters, two large groups were identified: one group displayed generally low cognitive abilities and one group was dominated by attention deficit symptoms. Conclusion: We found a surprisingly high number of positive rating scores in the cohort (30%). This could be explained, on the one hand, by known developmental disorders, such as mental retardation and learning disabilities, ADHD (Attention Deficit Hyperactivity Disorder) and pervasive developmental disorders, and, on the other hand, by prevalent milder cognitive dysfunctions that, in combination with inappropriate demands, seemed to lead to overt behavioural problems.
Low‐cost intervention to decrease mastitis among lactating women
Authors: Filteau S 
Published: August 2010

Mastitis is a common maternal health problem which can lead to serious infant health problems such as poor growth and HIV infection. Anti‐secretory factor (AF), which can be induced in milk by maternal consumption of a low‐cost cereal product, has been associated with decreased mastitis. Conclusion: Consumption of cereals which induce AF should be investigated as a potential intervention in less‐developed countries where the consequences of mastitis for infants are most severe.
Contributions of bone maturation measurements to the differential diagnosis of neonatal transient hypothyroidism versus dyshormonogenetic congenital hypothyroidism
Authors: Niu DM , Hwang B , Tiu CM , Tsai LP , Yen JL , Lee NC , Lin CY 
Published: August 2010

Aim: To a) evaluate the contribution of bone maturation in the diagnosis of neonatal transient hypothyroidism versus dyshormonogenetic congenital hypothyroidism in full‐term newborns, and b) use bone maturation to test the hypothesis that neonatal transient hypothyroidism is perinatal in onset. Materials and methods: The study included 20 patients with dyshormonogenetic and 43 with transient hypothyroidism. Thyroid function and measurements of the distal femoral epiphysis area, obtained at the time of first confirmatory diagnosis, were compared between the two groups. The epiphysis area in two control groups with normal thyroid function was also measured and compared with that in patients with transient hypothyroidism, at age 1–3 d (control A), or at the age when normal thyroid function was confirmed (control B). Results: Mean epiphysis area was 0.04 cm2 in patients with dyshormonogenetic versus 0.22 cm2 in patients with transient hypothyroidism (p < 0.0001). An area >0.05 cm2 was limited to patients with dyshormonogenetic hypothyroidism. Conversely, a normal area (>0.2 cm2) was only observed in patients with transient hypothyroidism. Mean epiphysis areas in control A (0.20 cm2) and in patients with transient hypothyroidism were similar (p= 0.37), consistent with perinatal onset of transient hypothyroidism. Mean epiphysis area in control B (0.31 cm2) was significantly greater than in patients with transient hypothyroidism (p < 0.01). Conclusions: A short duration of hypothyroidism can significantly delay bone maturation. Examination of bone maturation at initial confirmatory evaluation yields important information pertaining to congenital hypothyroidism, not only to predict intellectual development, but also to evaluate the risk of dyshormonogenetic hypothyroidism.
Breastfeeding and perceived changes in the appearance of the breasts: a retrospective study
Authors: Pisacane A ,   P Continisio, on behalf of the Italian Work Group on Breastfeeding
Published: August 2010

Aim: To investigate the association between breastfeeding and the perception that women have of changes in the appearance of their breasts. Methods: Four hundred and ninety‐six Italian women were interviewed in three health centres 18 mo (SD 3.4 mo, range 12.6–23.1 mo) after the birth of their first baby in May 2002. Information was collected on pregnancy, infant feeding and bra cup size before pregnancy. The main outcome measures were self‐reported changes in the appearance of the breasts (enlargement or reduction in breast size and loss of firmness) and bra cup size at the time of the interview. Results: Seventy‐three percent of the mothers reported that their breasts were different compared with before pregnancy; enlargement and loss of firmness representing the most common changes. The prevalence of changes among the mothers who had and had not breastfed was 75% and 69%, respectively (relative risk: 1.09, 95% CI: 0.96–1.23). Bra cup size before pregnancy was neither associated with the frequency of breastfeeding nor with the occurrence of changes in the appearance of the breasts. Conclusions: In Italy, mothers frequently report that the size and the shape of their breasts have changed after childbirth, but these changes do not seem to be associated with breastfeeding.
Positive pressure ventilation at neonatal resuscitation: review of equipment and international survey of practice
Authors: O'Donnell CPF , Davis PG , Morley CJ 
Published: August 2010

Background: The equipment used to provide positive pressure ventilation to newborns needing resuscitation at delivery varies between institutions. Devices were reviewed and their use surveyed in a sample of neonatal centres worldwide. Aim: To determine which equipment is used to resuscitate newborns at delivery in a sample of teaching hospitals around the world. Methods: A questionnaire was sent via e‐mail to a neonatologist at each of 46 NICUs in 23 countries on five continents, asking which resuscitation equipment they used. If it was not returned, follow‐up was by e‐mail. Results: Data were obtained from 40 (87%) centres representing 19 countries. Round face masks are used at 34 (85%) centres, anatomically shaped masks are used exclusively at six (15%) and a mixture of types are used at 11 (28%). Straight endotracheal tubes are used exclusively at 36 (90%) centres; shouldered tubes are used infrequently at three of the four centres that have them. The self‐inflating bag is the most commonly used manual ventilation device (used at 33 (83%) centres), the Laerdal Infant Resuscitator± the most popular model. Flow‐inflating bags are used at 10 (25%) centres. The Neopuff Infant Resuscitator± is used at 12 (30%) centres. Varying oxygen concentrations are provided during neonatal resuscitation at half of the centres, while 100% oxygen is routinely used at the other half. Conclusions: This survey shows considerable variation in practice, reflecting this lack of evidence and consequent uncertainty among clinicians. Comparison of the two most popular manual ventilation devices, the Laerdal Infant Resuscitator and the Neopuff Infant Resuscitator, is urgently required.
Up for grabs — Authors are a dime a dozen: The problem of multiple authors
Authors: Lazar R 
Published: August 2010

Aim: To outline some of the major ethical problems related to multiple authorship. Methods: A survey of the literature, data collected over the years, regarding multiple authors, e.g., definition, contribution, ethical behavior and guidelines, and personal experience were the primary inputs. Results: Despite the efforts of a number of editors' organizations, there still is a major problem in the attribution of authors' credits to those who had nothing to do with the writing. Conclusions: The solution to this problem may be found in one of two ways: strict enforcement of standards of authorship by journal editors, i.e., rejection of articles, no matter how good they may appear to be, because they violate these standards, and/or adoption of authorship standards as understood by commercial publishers.
Retrospective evaluation of long‐term efficacy and safety of splenectomy in chronic idiopathic thrombocytopenic purpura in children
Authors: Aronis S , Platokouki H , Avgeri M , Pergantou H , Keramidas D 
Published: August 2010

Aim: To review the long‐term efficacy and safety of splenectomy in children with chronic idiopathic thrombocytopenic purpura (cITP). Patients and methods: Data from 33 splenectomized children were retrospectively analysed (median follow up period: 18.8 y from the removal of the spleen). The median age of children at splenectomy was 12 y and the median ITP duration 3.3 y. Indications for splenectomy were: persistent severe thrombocytopenia with extensive purpura, epistaxis and/or gum bleeds, menorrhagia (n= 5) and severe or recurrent haemorrhage from various sites (n= 11). Results: Eighty‐five per cent of the patients showed an excellent (n= 26) or partial response to splenectomy. Five children (15%), all females, failed to respond. Of the responders, 25% experienced a transient recurrence of thrombocytopenia within 6 mo to 4 y from splenectomy. The mortality rate due to severe sepsis was 3%. However, the majority of the splenectomized patients have not so far suffered any severe or mild bacterial infection, despite incomplete vaccination and/or antibiotic prophylaxis. Conclusion: Splenectomy remains the only effective therapeutic modality for children with cITP, although it is associated with transient recurrence and rarely with post‐splenectomy sepsis, which could be fatal. Nonetheless, splenectomy should be the last treatment option for the cITP patient, after all available therapeutic modalities have been exhausted and the child still remains profoundly thrombocytopenic and symptomatic.