bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for venous thrombosis in Swedish children and adolescents
Authors: Rask Olof , Berntorp Erik , Ljung Rolf 
Published: August 2010

Abstract Aim: To identify prothrombotic risk profiles in children and adolescents referred to a regional coagulation centre in southern Sweden for a first thrombotic event. Methods: One hundred and twenty‐eight consecutive children and adolescents (newborn to 20 y) referred for evaluations of a first episode of venous thrombosis were investigated. Clinical data were collected retrospectively, and the following variables were investigated: protein C, protein S, antithrombin; resistance to activated protein C; the genotypes FV‐G1691A, F II‐G20210A, MTHFR‐C677T, MTHFR‐ A1298C; coagulation factors VIII and XI. Results: 104/128 subjects (81%) had identifiable acquired risk factors, most often indwelling catheters and hormone therapy. Predisposing genetic factors related to thromboembolic events were revealed in 53/83 (64%) of subjects who agreed to follow‐up blood sampling, and 17/83 (20%) had two or more inherited risk factors. Combinations of genetic and acquired risk factors were identified in 45/83 (54%) of the subjects, and 77/83 (93%) had at least one such risk factor. Both sexes had one peak in frequency at less than 1 y of age and then an increase during adolescence, more in females than in males. Plasma values for coagulation factors VIII and XI were age appropriate and showed a normal Gaussian distribution. Conclusion: This study identified prothrombotic risk profiles in almost all children and adolescents with venous thrombosis, which underlines the importance of careful evaluation of genetic and acquired risk factors.
Spirometry and lung function in children with congenital deafness
Authors: Jonsson Östen , Gustafsson Dan 
Published: August 2010

Abstract Aim: Deaf children do not develop a verbal language and will therefore not experience normal changes in airway pressure produced by speech. The impact on lung development of factors such as talking and screaming has not previously been investigated. Method: We performed spirometry in 51 children with congenital deafness without other medical problems and compared the results with 82 healthy hearing controls. Results: The deaf children had poorer spirometry results. They participated in the spirometry manoeuvre with less enthusiasm than the controls. This was due to difficulty in giving non‐verbal instructions in an enthusiastic way. When comparing only those in the two groups whose participation in the spirometry testing was evaluated as very good, poorer results were nevertheless obtained by the deaf group. Conclusion: We conclude that spirometry instructions for deaf children must be improved. Furthermore, a positive effect on lung development through use of the lungs for speech and screaming cannot be excluded.
Effectiveness of home‐based peer counselling to promote breastfeeding in the northeast of Brazil: A randomized clinical trial
Authors: Madeiro Leite Álvaro J , Fiorini Puccini Rosana , Atalah Álvaro N , Alves Da Cunha Antonio L , Tavares Machado Márcia 
Published: August 2010

Abstract Aims: To evaluate the effectiveness of home‐based peer counselling to increase breastfeeding rates for unfavourably low birthweight babies. Methods: Randomized clinical trial carried out in maternity hospitals and households in Fortaleza, one of the regions in Brazil with very low income; 1003 mothers and their newborns were selected in eight maternity hospitals. Newborns needed were healthy and weighed less than 3000 g. Intervention: Breastfeeding counselling, conducted by lay counsellors from the community, during home visits carried out on days 5, 15, 30, 60, 90 and 120 after birth. Main outcome measure: Feeding methods in the fourth month of life. Results: The intervention increased exclusive breastfeeding (24.7% vs 19.4%; p=0.044), delayed the introduction of formula and increased the time infants substituted breastfeeding to bottle milk (bottle milk 33.4% in the control group and 20.1% in the intervention group; p=0.00002). When comparing the frequency of artificial breastfeeding versus all other forms of breastfeeding (exclusive+predominant+partial), the intervention increased breastfeeding rates in 39% (RR=0.61; CI 95%: 0.50–0.75); 15% of children were free from artificial feeding (absolute risk reduction). The number of families to be visited to avoid one child receiving artificial feeding (NNT) was 7 (CI 95%: 5–13). Conclusions: Breastfeeding counselling, promoted by lay counsellors, can impact favourably on exclusive breastfeeding rates and contribute to delaying the utilization of milk formula and weaning. The intervention has great application potential because most cities in the northeast of Brazil count on community health workers that could do the counselling.
Italian paediatricians and off‐label prescriptions: Loyal to regulatory or guideline standards?
Authors: Pandolfini Chiara , Campi Rita , Clavenna Antonio , Cazzato Teresa , Bonati Maurizio 
Published: August 2010

Abstract Aim: To evaluate the reason off‐label use exists in paediatric general practice and to distinguish between non‐compliance with respect to regulatory standards and non‐compliance with respect to guidelines in order to determine what this difference means in terms of rational prescribing. Methods: Information on patients visited by 35 general paediatricians in southern Italy was collected and their prescriptions analysed for off‐label status. Off‐label drug use in the Italian paediatric community setting was assessed. A sample indication, pharyngotonsillitis, was chosen and the related prescriptions analysed, distinguishing between non‐compliance with regulatory standards (i.e. off‐label use) and non‐compliance with guidelines, in order to determine the appropriateness of prescribing. Results: Information was collected on 9917 patients (8476 prescriptions). In all, 17% of prescriptions were off label. When the 1675 pharyngotonsillitis prescriptions were analysed, 8% were off label and 63% were not in accordance with the guidelines. On the other hand, 55% of these prescriptions did not adhere to the guidelines, but were not off label either. Conclusion: The results of this study were surprising because off‐label drug use for pharyngotonsillitis, a common paediatric condition, was low, while non‐adherence to guidelines was high. In cases such as this one, in which guidelines exist, physicians' prescribing habits were irrational because they did not follow the evidence. Physicians should keep up to date with new knowledge and should be provided with updated product information.
Streptococcal toxic shock syndrome in children without skin and soft tissue infection: Report of four cases
Authors: Chiang Ming‐Chou , Jaing Tang‐Her , Wu Chang‐Teng , Hsia Shao‐Hsuan , Chiu Cheng‐Hsun 
Published: August 2010

AbstractStreptococcal toxic shock syndrome is a fulminant, highly fatal disease characterized by evidence of group A β‐haemolytic streptococcus infection and early shock with consecutive organ failure. In adults, affected individuals usually have preceding skin or soft tissue infection. However, in paediatric patients, except for varicella, the background focus is usually respiratory tract infection, and early diagnosis of streptococcal toxic shock syndrome in such patients is difficult. We report four previously healthy children with streptococcal toxic shock syndrome. Pharyngitis was identified in three cases. All of them had constitutional symptoms such as fever, vomiting, diarrhoea, abdominal pain and physical findings of tachycardia and diffuse abdominal tenderness, but no concomitant skin infection. Conclusion: Streptococcal toxic shock syndrome should be considered in paediatric patients with fever, vomiting, diarrhoea, abdominal pain and early shock. Early diagnosis, prompt initiation of antibiotics and aggressive fluid therapy are lifesaving for such patients.
Prothrombin and intraventricular haemorrhage
Authors: Fellman Vineta 
Published: August 2010

AbstractIn the study by Salonvaara et al., low prothrombin activity in preterm infants was associated with intraventricular haemorrhage (IVH). The interesting research question—do preterm infants who develop IVH have underlying coagulation disturbance?—could not be answered in this study. Conclusion: The association needs further investigation. The role of prothrombin in perinatal brain damage in the development of IVH and of white matter damage has to be further elucidated.
Somatostatin treatment of congenital chylothorax may induce transient hypothyroidism in newborns
Authors: Maayan‐Metzger Ayala , Sack Joseph , Mazkereth Ram , Vardi Amir , Kuint Jacob 
Published: August 2010

Abstract Aim: To describe a group of neonates with congenital, non‐traumatic chylothorax, one of whom developed transient hypothyroidism following treatment with somatostatin. Methods: The charts of seven infants with congenital chylothorax were reviewed in terms of their clinical presentation, the severity of their disease, the complications they presented and the duration of their hospitalization. Their pituitary–thyroid axis function was monitored in particular. Results: The seven infants, all preterm (32–34 wk), suffered from congenital chylothorax and hydrops fetalis diagnosed during the prenatal period. Four were treated by intrauterine drainage, and four had congenital malformations. Hospitalization lasted from 32 to 120 d. Three of the infants suffered from thrombocytopenia, three had chronic lung disease, and one suffered from Gram‐negative sepsis. The infant treated with somatostatin initially had normal thyroid function, but later developed primary transient hypothyroidism and was treated with L‐thyroxine. The thyroid screening tests for the infants who were not treated with somatostatin were all normal. Conclusions: Repeated doses of somatostatin were effective in reducing chylus production. Administering this treatment earlier should be considered in order to minimize known complications. The only potential side effect observed was primary transient hypothyroidism. Therefore, careful monitoring of the pituitary–thyroid axis is advised.
Host defence lectins in preterm neonates
Authors: Hilgendorff Anne , Schmidt Reinhold , Bohnert Anette , Merz Catherine , Bein Gregor , Gortner Ludwig 
Published: August 2010

Abstract Aim: Deficiency in collectins is discussed as a risk factor for pulmonary and systemic infections in children and adults. The objective of this study was to determine serum concentrations of surfactant protein D (SP‐D) and mannose‐binding lectin (MBL) in preterm and term infants at birth. Methods: 47 preterm infants below 32 wk gestational age (GA) and 19 healthy, term newborn infants at birth have been included in the study, and SP‐D as well as MBL concentrations have been determined in umbilical cord blood samples using sandwich ELISA technique. In addition, SP‐D concentrations were assessed in tracheal aspirates (TA) of 24 mechanically ventilated preterms and in infants without pulmonary complications before elective surgery. Results: MBL serum concentrations were significantly lower in preterms <32 wk GA (756.7 ng/ml; 14.6–11 184 ng/ml) compared to term newborns (3168.9 ng/ml; 282.3–7679.5 ng/ml; p=0.005; median and range, respectively). Serum SP‐D concentrations were significantly decreased in preterms between 28 and 32 wk GA (1.4 ng/ml; 0–4.6 ng/ml; n=26) compared to term infants (2.2 ng/ml; 1.2–3.3 ng/ml; p=0.05) and were found to positively correlate with history of antenatal corticosteroids and chorioamnionitis. SP‐D concentrations in TA were increased in preterm infants between 28 and 32 wk GA with respiratory distress syndrome (RDS) (25.0 ng/ml; 0.9–44.7 ng/ml; n=12) compared to control subjects (6.6 ng/ml; 0.5–30.4 ng/ml; n=12) in contrast to extremely immature infants <28 wk GA suffering from RDS (4.4 ng/ml; 0.8–78.4 ng/ml; n=12). Conclusion: In preterm infants, significant changes occur in collectin umbilical cord blood concentrations and pulmonary SP‐D levels. Functional aspects of these findings need to be addressed further.
Inflammatory chemokine expression in the peripheral blood of neonates with perinatal asphyxia and perinatal or nosocomial infections
Authors: Fotopoulos Spyros , Mouchtouri Alexia , Xanthou Georgina , Lipsou Niki , Petrakou Eftichia , Xanthou Marietta 
Published: August 2010

AbstractAim:The inflammatory response induced by perinatal infections and asphyxia is considered to participate in neonatal brain damage. Inflammatory responses are characterized by the expression of chemokines. Although chemokine levels have been investigated in healthy newborns, their role during neonatal pathological conditions has not been studied. The aim of our study was to examine chemokine serum levels in asphyxiated and infected neonates.Methods:Peripheral blood samples were obtained from perinatally asphyxiated and infected neonates during the first days of life and from neonates who developed nosocomial infections. Serum levels of interleukin‐8 (IL‐8), interferon‐γ‐inducible protein‐10 (IP‐10), monocyte chemoattractant protein‐1 (MCP‐1), macrophage inflammatory protein‐1α (MIP‐1α), and regulated upon activation, normal T cells expressed and secreted (RANTES) were determined.Results:In perinatally asphyxiated neonates, IL‐8 levels were significantly elevated on the 1st day of life. In perinatally infected neonates, IL‐8 and IP‐10 levels were significantly increased on the 1st day of life, while RANTES levels were significantly lower and remained so until the 4th day. In nosocomially infected neonates, IL‐8, IP‐10 and MIP‐1α levels were significantly increased on diagnosis of infection.Conclusion:The neonatal immune system is able to produce chemokines for the induction of an inflammatory response during perinatal asphyxia and perinatal or nosocomial infections. Blockade of inflammatory chemokines could possibly contribute to the prevention of brain damage.
Intraventricular haemorrhage in very‐low‐birthweight preterm infants: Association with low prothrombin activity at birth
Authors: Salonvaara Marjut , Riikonen Pekka , Kekomäki Riitta , Vahtera Elina , Mahlamäki Eija , Kiekara Olan , Heinonen Kirsti 
Published: August 2010

Abstract Aim: To determine the occurrence of intraventricular haemorrhage (IVH) and its association with coagulation factors at birth in preterm neonates born before 30 wk gestation. Methods: 38 neonates (median gestational age 27 wk, range 24–29 wk; median birthweight (BW) 933 g, range 515–1760 g) admitted to the neonatal intensive care unit were studied. Blood samples for coagulation factors were taken within 2 h after birth. The first cranial ultrasonographic examination was performed within the first 3 d. The occurrence of IVH was tested statistically by the Mann‐Whitney U‐test for association with the activity of coagulation factors and clinical variables. Results: Thirteen IVHs occurred within the first 3 d of life. IVH was associated with BW <1000 g (p=0.012), low mean blood pressure within the first 2 d (p=0.026), gestational age <27 wk (p=0.054), low Apgar scores (<7) at 1 min (p=0.078) and intrauterine growth restriction (p=0.072). At birth (samples drawn with a median of first 36 min of life), infants with subsequent IVH had statistically significantly lower prothrombin (factor II) activity (p=0.024) than infants without IVH. Conclusion: The measured low prothrombin may have been affected by a prior bleeding event. Nevertheless, preterm infants with low prothrombin activity may be susceptible to IVH, or to the progression of it, if left undiagnosed.
Breastfeeding and intelligence of preschool children
Authors: Slykerman RF , Thompson J M D , Becroft D M O , Robinson E , Pryor JE , Clark PM , Wild CJ , Mitchell EA 
Published: August 2010

Abstract Aim: To investigate whether breastfeeding during infancy is a determinant of intelligence at 3.5 y. Methods: Five hundred and fifty European children enrolled at birth in the Auckland Birthweight Collaborative Study were assessed at 3.5 y of age. Approximately half were small for gestational age (SGA10th percentile) at birth and half were appropriate for gestational age (AGA>10th percentile). Duration of breastfeeding was recorded at maternal interview, and the intelligence of children was assessed using the Stanford Binet Intelligence Scale. Regression analysis was used to calculate estimates of difference in intelligence scores between breastfeeding groups for the total sample and the group of SGA children. Analyses of the total sample were weighted to account for the disproportionate sampling of SGA children. Results: Breastfeeding was not significantly related to intelligence scores in the total sample despite a trend for longer periods of breastfeeding to be associated with higher intelligence scores. However, in the SGA group, breastfeeding was significantly related to IQ at 3.5 y. Small for gestational age children who were breastfed for longer than 12 mo had adjusted scores 6.0 points higher than those who were not breastfed (p=0.06). Conclusion: Breastfeeding may be particularly important for the cognitive development of preschool children born small for gestational age.
Somatic factors at 8 years of age in children with recurrent use of antibiotics in early infancy
Authors: Louhi‐pirkanniemi Katri , Rautava Päivi , Aromaa Minna , Sahlberg Anna , Mertsola Jussi , Helenius Hans , Sillanpää Matti 
Published: August 2010

Abstract Aim: To examine the influence of recurrent therapy with antibiotics (RTA) in infancy on children's somatic factors at 8 y of age. Methods: Subject selection was based on stratified randomized cluster sampling. Altogether 1287 infants were potential participants in the follow‐up study. Children with 6 courses of antibiotics (100 children) during their first 18 mo of life and children with no (62%) or 2 courses (38%) of antibiotics participated in a clinical examination in a case‐control setting (100 matched controls) at the age of 8 y. Results: The children with RTA continued to have more infections and had had more courses of antibiotics compared to controls during the follow‐up. There was no clinically significant difference in the somatic and dental status at the age of 8 between the two groups. The parents of the children with RTA reported significantly more often recurrent infections than the parents of the controls. Conclusions: The children with recurrent therapy with antibiotics in early childhood also continue to be prescribed more antibiotics in later childhood when compared to those who received no or few antibiotics in infancy. However, recurrent infections and medications do not seem to have a marked effect on the somatic and dental status of these children at 8 y of age.
Bone resorption in infants of diabetic mothers
Authors: Lapillonne Alexandre , Glorieux Francis H , Salle Bernard L 
Published: August 2010

Abstract Aim: Previous studies, using different techniques, have yielded contradictory findings concerning whether bone remodelling is altered in infants of diabetic mothers (IDM). The objective of the study was to assess the bone resorption of IDM during the first 3 mo of age. Methods: We conducted a longitudinal study using a specific index of bone resorption, urinary excretion of collagen type I cross‐linked N‐telopeptide (NTX), to compare bone resorption of a cohort of IDM and that of age‐matched controls throughout the first 3 mo of life. Results: NTX/Cr ratio in IDM followed the same pattern over time as observed in control infants, i.e., a rapid increase during the first 10 d of life, a peak at 1 mo of life, and then a progressive decrease at 3 mo of life. There was no statistically significant difference between urinary NTX excretion observed in IDM and that observed in controls at any age studied. Conclusion: By using urinary NTX excretion, normal bone resorption was found in IDM throughout the first 3 mo of life.
Clinical presentation and follow‐up of patients with the attenuated phenotype of mucopolysaccharidosis type I
Authors: Vijay Suresh , Ed Wraith J 
Published: August 2010

Abstract Aim: To review the heterogeneity and severity of the clinical features at the attenuated end of the mucopolysaccharidosis (MPS) type I disease spectrum. Methods: The course of disease in 29 patients with attenuated mucopolysaccharidosis I who attended the MPS clinic in Manchester, UK, was reviewed. Results: For more than half of the patients, onset of symptoms was in the first 2 y of life, and the age at diagnosis ranged from 15 mo to 40 y. Joint stiffness, corneal clouding, umbilical hernia and recurrent ear, nose and throat symptoms were the commonest features at presentation. Patients experienced significant morbidity during the course of this inherited disease. Skeletal problems predominated and cardiac valve pathology, upper airway obstruction and hearing deficits were detected in a notable number of patients. Nerve decompression for carpal tunnel syndrome, cervical cord decompression, and grommet insertion for serous otitis media were the most frequent surgical interventions. Conclusion: Clinical presentation of attenuated (“non‐Hurler”) mucopolysaccharidosis type I is heterogeneous in time of onset and types of clinical features. A better understanding of the spectrum of disease and of the related disease progression will contribute to more accurate diagnosis, and patients will benefit from early intervention.
Implementation of kangaroo mother care: A randomized trial of two outreach strategies
Authors: Pattinson Robert C , Arsalo Irmeli , Bergh Anne‐Marie , Malan Atties F , Patrick Mark , Phillips Noel 
Published: August 2010

Abstract Aim: To test whether a well‐designed educational package on the implementation of kangaroo mother care (KMC) used on its own can be as effective in implementing KMC in a healthcare facility as the combination of a visiting facilitator used in conjunction with the package. Setting: Thirty‐four hospitals in KwaZulu‐Natal Province, South Africa. Method: The hospitals were paired with respect to their geographical location and annual number of births at the facility. One hospital in each pair was randomly allocated to receive either the implementation package alone (group A) or the implementation package and visits from a facilitator (group B). Hospitals in group B received three facilitation visits. All hospitals were evaluated by a site visit 8 mo after launching the process and were scored by means of a progress‐monitoring tool. Outcomes: Successful implementation was regarded as demonstrating evidence of practice (score>10) during the site visit. Results: Group B scored significantly better than group A (p<0.05). All 17 hospitals in group B demonstrated evidence of practice, with the median score of the group being 15.44 (range 10.29–22.94). Twelve of the hospitals in group A demonstrated evidence of practice and the median score was 11.33 (range 1.08–21.13). Conclusion: Successful implementation was achieved in most of the hospitals irrespective of the strategy used. However, facilitation with an implementation package was clearly superior to using a package alone. Some sites do not need facilitation for successful implementation.