bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse drug events in children during hospitalization and after discharge in a Norwegian University Hospital
Authors: Buajordet I , Wesenberg F , Brørs O , Langslet A 
Published: August 2010

The frequency and characteristics of adverse drug events (ADEs) in children hospitalized in the paediatric department of Ullevaal University Hospital, Norway, were determined using intensive monitoring. Of 579 children treated with drugs, 28% experienced ADEs; 7% at the time of admission, 18% during hospitalization and 9% after discharge. All children treated for cancer, 19% treated with anti‐infective drugs, 15% treated with antiasthmatics and 10% treated with drugs affecting the nervous system experienced ADEs. The most frequent events were gastrointestinal, CNS‐ and skin reactions and 19% were considered as serious. ADEs caused 6% of the admissions and 44% required interventions. Most ADEs were found by screening patient records, where physicians mostly described adverse drug events requiring interventions and nurses described less serious events. Parents reported 14% of the events, of which a majority were CNS reactions. CNS reactions may be more common than expected and observations by parents are important when investigating such reactions in children. Conclusions: ADEs, mainly gastrointestinal, CNS and skin reactions related to drugs affecting the nervous system, anti‐infectives and antiasthmatics, were seen in 28% of the patients. The reporting of events by parents was a useful supplement to the screening of patient records.
Orbital lymphangioma with non‐contiguous cerebral arteriovenous malformation, manifesting with thrombocytopenia (Kasabach‐Merritt syndrome) and intracerebral hemorrhage
Authors: Vachharajani A , Paes B 
Published: August 2010

This study describes the first reported case in a preterm infant of an orbital lymphangioma with non‐contiguous cerebral arteriovenous malformation, manifesting with thrombocytopenia (Kasabach‐Merritt syndrome) and intracerebral hemorrhage. Conclusion: Neonates presenting with orbital lymphangiomas should undergo radiological investigations of the lesion and a detailed cerebral evaluation for associated arteriovenous developmental anomalies.
Randomized double‐blind controlled trial on the effects on iron status in the first year between a no added iron and standard infant formula received for three months*
Authors: Tuthill DP , Cosgrove M , Dunstan F , Stuart ML , Wells JCK , Davies DP 
Published: August 2010

Recent research has not only questioned the necessity of iron supplementation in human milk substitutes prior to weaning, but also suggested some potential adverse effects. This study investigated the hypothesis that infant formula need not contain added iron in the first 3 mo. Healthy term infants were recruited into a double‐blind controlled trial and randomized to receive either a new no added iron formula (New; <0.1 mg Fe 100 ml−1) or a standard formula (Standard; 0.5 mg Fe 100 ml−1) for the first 3 mo of life. A breastfed reference group was also studied. Iron status was assessed at 3 and 12 mo from heel‐prick capillary blood samples evaluated by full blood‐count analysis, including reticulocytes and serum ferritin. In total, 149 infants were entered (51 New, 49 Standard, 49 breastfed) with no differences between the groups in gender distribution, birthweight, gestation or numbers completing the study. There were no significant differences between the principal outcome measures: mean values for haemoglobin, mean cell volume and ferritin, between the two formula‐fed groups, and the proportion with a haemoglobin level <11 g dl−1 or ferritin <10 μg l−1 did not differ. Conclusion: The use of a “no added iron” infant formula in place of an iron‐fortified formula during the first 3 mo of life did not clinically affect iron status at 3 and 12 mo of age. The universal supplementation of formulae with iron during this initial period needs further consideration.
Inadequate leptin level negatively affects body fat loss during a weight reduction programme for childhood obesity
Authors: del Giudice E Miraglia , Santoro N , Marotta A , Nobili B , Di Toro R , Perrone L 
Published: August 2010

Obesity is a typical example of a complex multifactorial disease arising from behavioural, environmental and genetic factors that may affect individual responses to dietary intake and physical activity. Observational, longitudinal dietary interventional studies in obese patients present contrasting reports on the predictive value of baseline leptin levels. We report on the effect of a weight reduction programme in three different groups of obese children (82 patients in all) assembled on the basis of their baseline leptin levels adjusted for body mass index (BMI), gender and pubertal development. The effectiveness of this programme was decreased in patients with relative hyperleptinaemia or hypoleptinaemia compared to children with baseline leptin levels appropriate to BMI gender and pubertal development. Conclusion: Information gained from leptin assays could provide predictive insight into an individual's ability to lose body fat and may therefore have important implications for our approach to the treatment and prevention of childhood obesity.
Use of the lactose H2breath test to monitor mucosal healing in coeliac disease
Authors: Murphy MS , Sood M , Johnson T 
Published: August 2010

Confirmation of the diagnosis of coeliac disease requires unequivocal evidence of recovery on a gluten‐free diet. The lactose H2breath test is a non‐invasive technique for detecting lactose malabsorption, and this may occur in untreated coeliac disease. The utility of this test was investigated in objectively confirming a response to gluten exclusion. The study included 44 children from 0.9 to 14.75 y of age (median 3.2) with coeliac disease. Five children were asymptomatic, being identified through coeliac antibody screening. Breath tests were performed prior to dietary treatment. If positive, they were repeated at 4‐wk intervals following gluten exclusion. Overall, 21/44 (48%) children had positive breath tests at presentation. In 18/21 children on a gluten‐free diet, this became negative after 4 wk (86%) and in all the children by 8 wk. In two children with positive tests at 4 wk, problems with dietary adherence were identified. A positive test before treatment was not associated with significant differences in individual symptoms, height, weight and body mass index standard deviation scores, serum haemoglobin or albumin. However, no positive results were found in the asymptomatic patients (p= 0.05). Lactose malabsorption was associated with earlier age of presentation (p= 0.008).Conclusion: The lactose H2breath test objectively confirms a response to gluten exclusion. In selected cases it can help confirm a diagnosis of coeliac disease. However, the test tends to be less informative in asymptomatic patients, and in older children.
Working together: neonatal nurse practitioners in practice
Authors: Redshaw ME , Harvey ME 
Published: August 2010

The aim of this study was to examine the relatively new role of neonatal nurse practitioners (NNPs) in the United Kingdom, comparing practice in different types of neonatal units and work undertaken by junior medical staff (JMS). Diary checklists sent to the total population of qualified NNPs in neonatal units (NNUs) and JMS in six regional centres with qualified NNPs were returned from 68 out of 109 qualified NNPs (62%), working in 50 different NNUs and from 25 out of 48 JMS (52%). Direct observations (totalling 263.5 h) were made by an experienced neonatal nurse researcher on 30 different NNPs. Frequencies of activities and specific procedures were compared between groups. Observational measures included type and duration of activity and interactions with other members of staff. NNPs were found to be undertaking a range of activities: in the NNU, which usually involved blood sampling, siting of intravenous cannulae, presenting at ward rounds and teaching. Outside the unit, NNPs attended the delivery suite and the postnatal ward. Significant differences were found in the nature and organization of their work in different types of NNUs. A comparison between NNPs and JMS showed similar activities, with greater direct involvement by NNPs in the NNU and in teaching. The diary data were supported by observations and together these are evidence of current NNP practice.Conclusion: To a large extent there is an overlap in the work of JMS and NNPs in neonatal units, but although the clinical work and areas of activity are similar, there are differences in emphasis and in work organization.
How clinicians in neonatal care see the introduction of neonatal nurse practitioners
Authors: Redshaw ME , Harvey ME 
Published: August 2010

The aim of this study was to investigate the views of UK clinicians in neonatal care who were working with nurses trained as neonatal nurse practitioners (NNPs). A questionnaire survey was used with a total sample of senior clinicians in the 66 neonatal units with one or more qualified NNPs. The main outcome measures were type and frequency of response, and similar data from NNPs were used to make comparisons. Data were returned from 57 of the 66 clinicians contacted (86%). NNP clinical practice as perceived by them was largely similar to that recorded by NNPs, though the clinicians expected more NNP involvement in some procedures (inserting central venous lines, umbilical arterial catheters, chest drains and peripheral arterial cannulae) than was actually found. Perceptions of the NNP role were similar, though the clinicians were significantly less likely to see taking a case‐load, conducting a ward round, accepting outside referrals and taking charge of emergency transfers as integral elements. Reflections on the utilization of NNPs in neonatal care and the impact on junior medical staff education referred to NNPs filling gaps, a reduction in the intensity of work, improvements in training and in the quality of care. Conclusion: The introduction of NNPs is seen positively from the perspective of clinicians working alongside them in neonatal care. The development of similar models of care in countries where the introduction of NNPs is being considered is likely to be similarly supported.
A new transcutaneous bilirubinometer, BiliCheck, used in the neonatal intensive care unit and the maternity ward
Authors: Ebbesen F , Rasmussen LM , Wimberley PD 
Published: August 2010

Transcutaneous bilirubin (TcB) was measured with a new bilirubinometer, BiliCheck, in 261 jaundiced infants in the neonatal intensive care unit (NICU) [gestational age (GA) 25–43 wk] (group 1) and in 227 healthy jaundiced term and near‐term infants (GA 35–43 wk) (group 2). Imprecision of a single determination of TcB measured on the forehead [TcB(h)], expressed as 1 standard deviation, was 15–18 μmol l−1. No statistically significant difference between intraoperator and interoperator imprecision was found. There was a good correlation between TcB(h) and total serum bilirubin (TSB) in both groups of infants, although TcB(h) was on average lower than TSB. In the NICU infants, TcB(h), other things being equal, was lower in males than in females, and decreased with increasing postnatal age, for the same TSB level. In the infants in both groups who had a GA ≥35 wk, sick infants had a higher TcB(h) than healthy infants for the same TSB level. The differences were statistically significant, but small and of minor clinical significance. Blood haemoglobin concentration, GA and ethnic origin were not found to influence TcB(h), i.e. BiliCheck corrects sufficiently for these factors. In all 488 infants, TcB was measured at four different body sites. Measurements on the forehead and sternum [TcB(s)] correlated well with TSB, while measurements on the knee and foot correlated less well. In the NICU infants TcB(h) predicted TSB statistically significantly better than TcB(s), while in the healthy term and near‐term infants TcB(h) and TcB(s) predicted TSB equally well. Therefore, the preferable body site for measurement of TcB under routine conditions is the forehead. By retrospective analysis of the data, a screening model is presented whereby TcB(h) can be used to screen infants who require phototherapy. We found that using screening limits for TcB(h), which are 70% of the currently used phototherapy limits for TSB, 80% of blood samples in healthy term and near‐term infants, and 42% of NICU infants with GA ≥32 wk, could be avoided. Conclusion: BiliCheck is suitable for screening both NICU and healthy newborn infants with jaundice, with regard to the need for phototherapy. The authors recommend using a TcB(h) limit which is 70% of the currently recommended TSB limits for phototherapy, to decide whether TSB needs to be measured.
Early versus late treatment of posthaemorrhagic ventricular dilatation: results of a retrospective study from five neonatal intensive care units in The Netherlands
Authors: de Vries LS , Liem KD , van Dijk K , Smit BJ , Sie L , Rademaker KJ , Gavilanes AWD ,   Dutch Working Group of Neonatal Neurology
Published: August 2010

Posthaemorrhagic ventricular dilatation (PHVD) in very preterm infants carries a poor prognosis. As earlier studies have failed to show a benefit of early intervention, it is recommended that PHVD be first treated when head circumference is rapidly increasing and/or when symptoms of raised intracranial pressure develop. Infants with PHVD, admitted to 5 of the 10 Dutch neonatal intensive care units were studied retrospectively, to investigate whether there was a difference in the time of onset of treatment of PHVD and, if so, whether this was associated with a difference in the requirement of a ventriculo‐peritoneal (VP) shunt and/or neurodevelopmental outcome. The surviving infants with a gestational age ≤34 wk, born between 1992 and 1996, diagnosed as having a grade III haemorrhage according to Papile on cranial ultrasound and who developed PHVD were included in the study. PHVD was defined as a ventricular index (VI) exceeding the 97th percentile according to Levene (1981), and severe PHVD as a VI crossing the p 97 + 4 mm line. Ninety‐five infants met the entry criteria. Intervention was not deemed necessary in 22 infants, because of lack of progression. In 31 infants lumbar punctures (LP) were done before the p 97 + 4 mm line was crossed (early intervention). In 20/31 infants, stabilization occurred. In 9 a subcutaneous reservoir was placed, with subsequent stabilization in 6. In 5/31 infants a VP shunt was eventually inserted. In 42 infants treatment was started once the p 97 + 4 mm line was crossed (late intervention). In 30 infants LPs were performed and in 17 of these a VP shunt was eventually inserted. In 11 infants a subcutaneous reservoir was immediately inserted and in 8 of these infants a VP shunt was needed. In one infant a VP shunt was immediately inserted, without any other form of treatment. Infants with late intervention crossed the p 97+ 4 mm earlier (p 0.03) and needed a shunt (26/42; 62%) more often than those with early intervention (5/31; 16%). Early LP was associated with a strongly reduced risk of VP‐shunting (odds ratio = 0.22, 95% confidence interval: 0.08–0.62). The number of infants who developed a moderate or severe handicap was also higher (11/42; 26%) in the late intervention group, compared with those not requiring any intervention (3/22; 14%) or treated early (5/31; 16%). Conclusion: In this retrospective study, infants receiving late intervention required shunt insertion significantly more often than those treated early. A randomized prospective intervention study, comparing early and late drainage, is required to further assess the role of earlier intervention.
Language impairment in Swedish bilingual children: a comparison between bilingual and monolingual children in Malmö
Authors: Salameh EK , Nettelbladt U , Håkansson G , Gullberg B 
Published: August 2010

In this study two groups of children were compared, 192 bilingual and 246 monolingual, referred over a 12‐mo period to University Hospital in Malmo for suspected language impairment. Compared with monolingual children, bilingual children ran a significantly lower risk (RR = 0.76, p < 0.0001) of being referred by a child health centre, and a significantly higher risk (RR = 1.54, p < 0.0103) of being referred after 5 y of age. In the bilingual group there was also a significantly higher risk of parental refusal of assessment (RR = 2.35, p<0.0016) and of the children being diagnosed with a severe language impairment (RR=1.87, p<0.0009). The risk for bilingual children with severe language impairment being discharged owing to non‐attendance was high (RR = 6.20, p < 0.0002) compared to monolingual children. The risk increased with severity of language impairment. Conclusion: Bilingual children displayed a higher risk of a diagnosis of severe language impairment and of being discharged for non‐attendance. The problem of low compliance among bilingual parents, despite strong indications of parental distress, must be addressed.
Cerebral venous sinus thrombosis in a neonate due to factor V Leiden deficiency
Authors: Abrantes M , Lacerda AF , Abreu CR , Levy A , Azevedo A , Da Silva LJ 
Published: August 2010

A case is described of cerebral venous sinus thrombosis due to factor V Leiden deficiency that occurred in the neonatal period, presenting with seizures. Diagnosis was based on ultrasonography, Doppler ultrasound (US) and magnetic resonance imaging (MRI). The aetiology was only recognized after blood‐clotting tests, antithrombin III, C and S protein levels and factor V Leiden were studied. This situation was treated with intravenous heparin controlled by activated partial thromboplastin time (APTT). MRI angiography and Doppler US were important in the follow‐up. It is important to assess periodically the neurological development of the baby and to prevent situations such as dehydration or severe infection, which can precipitate further thrombotic events. Molecular genetics allowed the identification of this trait in other family members. Conclusion: In every newborn with a thrombotic episode, coagulation studies must be performed, including testing for activated protein C (APC) resistance. Doppler US flow measurement and the MRI studies provide the best tools for diagnosis and follow‐up. Heparin should be given to double the initial individual APTT. It is important to prevent any risk situation such as dehydration or severe infection, which could lead to a recurrence of a thrombotic episode. Regular assessment of the child's neurodevelopment is an important aspect of further care.
Progressive nature of aspartylglucosaminuria
Authors: Arvio P , Arvio M 
Published: August 2010

Descriptions of the outcome of aspartylglucosaminuria (AGU) were analysed, and a comprehensive summary table of symptoms and signs by age was designed. Conclusion: The multifarious progressive nature of AGU is obvious in the skills and abilities of patients, as well as in their personality, general health and physical appearance.
Effect of breastfeeding on cognitive development of infants born small for gestational age
Authors: Rao MR , Hediger ML , Levine RJ , Naficy AB , Vik T 
Published: August 2010

Breastfeeding during infancy appears to result in enhanced cognitive development during childhood, but it is not known whether breastfeeding should be encouraged for infants born small for gestational age (SGA) whose growth might otherwise benefit from nutritional supplementation. To address this issue, duration of exclusive breastfeeding and cognitive development were evaluated prospectively for 220 term children born SGA and 299 term children born appropriate for gestational age (AGA). Cognitive development was assessed using the Bayley Scale of Infant Development at 13 mo and Wechsler Preschool and Primary Scales of Intelligence at 5 y of age. Infants born SGA were given supplemental foods significantly earlier than those born AGA. Growth of infants born SGA was not related to early nutritional supplementation. The salutary effect of exclusive breastfeeding on cognitive development was greater for children born SGA than for those born AGA. Based on a linear association between duration of exclusive breastfeeding and intelligence quotient (IQ), children born SGA and exclusively breastfed for 24 wk were predicted to have an 11‐point IQ advantage over those breastfed for 12 wk, as opposed to a 3‐point advantage for children born AGA with similar durations of breastfeeding. The IQ distribution of children born SGA and exclusively breastfed for more than 12 wk was not different from that of all children born AGA. Conclusion: Duration of exclusive breastfeeding has a significant impact on cognitive development without compromising growth among children born SGA. These data suggest that mothers should breastfeed exclusively for 24 wk to enhance cognitive development.
Increased inspiratory effort in infants with a history of apparent life‐threatening event
Authors: Horemuzova E , Katz‐Salamon M , Milerad J 
Published: August 2010

The objective of this study was to compare the results of polysomnography between infants with a history of apparent life‐threatening event (ALTE) and controls. In this case‐control study, 40 full‐term ALTE infants, aged 2–36 wk at the time of the event, were compared with 40 age‐ and sex‐matched randomly selected controls. SaO2, tcpO2, tcpCO2, heart rate (HR), vector of rib cage and abdominal respiratory movements (phase angle, as an index of inspiratory effort) were recorded during natural nocturnal active and quiet sleep (AS, QS). SaO2, tcpO2, tcpCO2 were similar in ALTE and controls in both sleep states. Phase angle was increased in ALTE infants in both AS (59 ± 46 vs 26 ± 17°) and QS (53 ± 46 vs 18 ± 14, p < 0.001). Eleven ALTE infants (27.5%) experienced SaO2 < 90%, with a mean decrease in SaO2 to 86 ± 1.6% (mean ± SD), compared with 10% for controls (p= 0.003). In eight ALTE infants, SaO2 values < 90% were linked to thoracoabdominal asynchrony. SaO2 < 90% in conjunction with HR < 100 bpm were detected in three ALTE infants and one control. Periodic breathing was observed in 45% of ALTE infants and 40% of controls. Conclusion: The mean values of oxygen saturation, tcpO2 and carbon dioxide levels in ALTE infants are comparable with those of healthy controls but the ALTE infants exhibit more hypoxaemic episodes and increased inspiratory effort during sleep.
Septicaemia due to glucose non‐fermenting, Gram‐negative bacilli other than Pseudomonas aeruginosa in children
Authors: Ladhani S , Gransden W 
Published: August 2010

Bloodstream infections due to non‐fermenting Gram‐negative bacilli other than Pseudomonas aeruginosa (NF‐GNB) are uncommon in children but their incidence is reported to be increasing. The aim of this study was to determine the characteristics of such infections in children in a London teaching hospital. All paediatric patients with positive NF‐GNB blood cultures and clinical evidence of sepsis between July 1995 and June 2000 were included in the study. A total of 10278 blood cultures was performed, of which 356 (3.5%) represented clinically significant episodes of bacteraemia. Of these, 12 (0.1%) were due to NF‐GNB. Nine of the 12 (75%) patients were receiving haemodialysis for end‐stage renal failure (ESRF). Only one patient was receiving immunosuppressive therapy and none was neutropenic or had any malignancy. An intravascular catheter was identified as the focus of infection in all 12 cases. Stenotrophomonas maltophilia was the most common organism isolated (67%). Six patients were successfully treated with antibiotics alone. Four others received antibiotics, but also required line removal, and two patients responded to line removal without the need for antibiotics. Conclusion: An association was found between ESRF and NF‐GNB infections, possibly related to the requirement for long‐term catheters for dialysis. Antibiotic treatment alone was only successful in half the cases of catheter‐related NF‐GNB septicaemia, while removal of the infected catheter ensured complete cure in the cases where antibiotic treatment alone did not suffice.