bluuebunny/crossref_metadata_2025_split huggingface dataset:
Parenteral lipids and the preterm infant: between Scylla and Charybdis
Authors: Pitkänen OM 
Published: August 2010

Intravenous lipid infusions are a valid option for a dense source of energy and essential fatty acids when the enteral route is unavailable. However, the use of these preparations in neonatal patients has been associated with metabolic concerns such as oxidative stress, and complications such as abnormal vascular tone, intravascular fat deposition and even fat embolism.Conclusion: Metabolic issues related to nutrient accretion and noxious biological reactions should be considered when prescribing parenteral lipids with high PUFA content to the critically ill newborn infant.
Ghanaian infant growth study
Authors: Whitehead RG 
Published: August 2010

The future revised WHO growth references for infancy and early childhood will have an international basis rather than just an American one, as is the case with the current NCHS/WHO ones. The anthropometric data for analysis will be collected from babies breastfed in accordance with WHO guidelines. An important stipulation, however, is that their growth must have been unrestricted by environmental factors. A paper from Ghana describes a quantitative provisional study that has revealed how such a condition can be satisfied within a developing country.Conclusion: Family income and especially the higher education of the father up to university level can still be important variables in the achievement of optimal growth of babies, even those brought up in situations of relative affluence.
Faecal elastase‐1 test is superior to faecal lipase test in the assessment of exocrine pancreatic function in cystic fibrosis
Authors: Walkowiak J , Lisowska A , Przyslawski J , Grzymislawski M , Krawczynski M , Herzig KH 
Published: August 2010

Background and aims: Direct tests are characterized by the highest sensitivity and specificity. However, their practical use, especially in children, is limited. Among the indirect tests, the highest sensitivity and specificity was documented for faecal elastase‐1 test, yet the value of faecal lipase test in cystic fibrosis (CF) has not been defined. Therefore, the aim of the present study was to compare the sensitivity and the specificity of the faecal lipase test to the faecal elastase‐1 test in the assessment of exocrine pancreatic function in children with CF. Methods: The study comprised 90 CF patients and 95 healthy subjects (HS). In all subjects, faecal elastase‐1 concentrations (ELISA) and lipase activities (ELISA) were measured. The presence of pancreatic insufficiency was documented by the determination of faecal fat excretion in 78 pancreatic insufficient and by the secretin‐cholecystokinin test in 12 CF patients without steatorrhoea. Sensitivity and specificity of the faecal elastase‐1 test and faecal lipase test were analysed and, in 50 HS, sample‐to‐sample and day‐to‐day variations were determined. Results: With cut‐off levels providing the same specificity for both tests (95.8%), the sensitivity of the faecal elastase‐1 test (91.1%) was significantly higher (p > 0.0036) than that of the faecal lipase test (76.7%). Sample‐to‐sample (mean ± SEM: 13.2 ± 1.2% vs 23.4 ± 2.2%) and day‐to‐day variations (mean ± SEM: 16.3 ± 1.2% vs 32.5 ± 2.6%) were significantly lower (p > 0.0001) for elastase‐1 than for lipase measurements.Conclusion: Among indirect tests, faecal elastase‐1 test is superior to faecal lipase test in the assessment of exocrine pancreatic function in cystic fibrosis.
The natural course of gastro‐oesophageal reflux
Authors: Salvatore S , Hauser B , Vandenplas Y 
Published: August 2010

Gastro‐oesophageal reflux disease is a common phenomenon usually consistent with a benign prognosis. But alarm symptoms and complications occur at any age, and may be difficult to recognize clinically although requiring prompt and adequate intervention. Many unsettled issues in gastro‐oesophageal reflux (disease) are encountered in its natural course and clinical presentation. Severity of reflux is much more related to complications than to the amount of reflux. Current medical reflux treatment with H2‐receptor antagonists and preferably with proton pump inhibitors is efficient in controlling symptoms and healing oesophagitis. Whether early treatment of mild reflux significantly changes the incidence or severity of symptoms and complications in adulthood is uncertain. Atopic disease is now recognized to cause reflux‐like symptoms. Paediatricians should adequately consider the impact on the quality of life of repetitive regurgitation.Conclusion: Further research is needed to define more clearly how many, which and why some children with reflux disease progress to persisting chronic disease and others do not.
Ethical issues in research on control of the HIV/AIDS epidemic: report from a workshop of the World Federation of Scientists, Erice, Sicily, Italy, 22–24 August 2003
Authors: de Thé G , Buonaguro F , Charpak N , Hutton JL , Thorstensson R , Valdas E , Zetterström R 
Published: August 2010

In research on control of the HIV/AIDS epidemic there are many ethical issues to be considered. The problem of personal autonomy versus the interest of society to prevent the spread of the disease in various settings makes it difficult to follow the regulations of the Declaration of Helsinki in all respects. This is particularly clear in the evaluation of trials aimed at preventing mother‐to‐child transmission of HIV. The interest of the child does not always conform to the policy of avoiding stigmatization of the mother.Conclusion: Programmes for the implementation of antiretroviral therapy and vaccine trials may differ in countries with different mean incomes of the inhabitants, and are also influenced by local patterns. For this reason, the Declaration of Helsinki should be changed in such a way that it conforms with the ways in which it may be possible to combat such a disastrous epidemic as that caused by HIV.
Midazolam and amplitude‐integrated EEG in asphyxiated full‐term neonates
Authors: van Leuven K , Groenendaal F , Toet MC , Schobben AFAM , Bos SAJ , de Vries LS , Rademaker CMA 
Published: August 2010

Aim: In the present, prospective study, the relation between the levels of midazolam, its two active metabolites—1‐hydroxy‐midazolam (OH‐midazolam) and 1‐hydroxy‐midazolam‐glucuronide (glumidazolam)—and the aEEG were examined. Patients and methods: Fifteen full‐term neonates with seizures due to hypoxic‐ischaemic encephalopathy admitted to our NICU were included. Midazolam (loading dose 0.05 mg/kg in 10min, maintenance dose 0.15mg/kg/h) was used as an add‐on anti‐convulsant after phenobarbital and lidocaine because of continuing seizures. Amplitude‐integrated EEG background pattern was scored at the start of midazolam and at the time of blood sampling as continuous normal voltage (CNV), discontinuous normal voltage (DNV), burst suppression (BS), continuous low voltage (CLV) or flat trace (FT). Serum levels of midazolam, OH‐midazolam and glu‐midazolam were measured at least 8 h after the start with HPLC. Results: In 11/15 patients, seizures were abolished with the addition of midazolam. In the remaining patients, seizure frequency was reduced in one and unchanged in three. Amplitude‐integrated EEG background pattern at the start of midazolam was CNV in two, DNV in six, BS in five and CLV in two. Moderate, temporary suppression of the aEEG background pattern lasting less than 2h was seen in four neonates. Amplitude‐integrated EEG at midazolam sampling was CNV in two, DNV in seven, CLV in two and FT in four. Serum levels of midazolam ranged from 0.10 to 1.76 mg/l, OH‐midazolam from 0.05 to 0.28 mg/l and glu‐midazolam from 0.85 to 4.36 mg/l. Conclusions: A brief and moderate suppression of the aEEG background pattern immediately after midazolam was seen in four neonates for less than 2 h. Suppression at a later time point, i.e. after more than 8 h of midazolam infusion, was demonstrated almost exclusively in neonates with a poor background pattern, and therefore these patterns appear to be determined mainly by the severity of hypoxic‐ischaemic encephalopathy.
Why do parents hesitate to vaccinate their children against measles, mumps and rubella?
Authors: Alfredsson R , Svensson E , Trollfors B , Borres MP 
Published: August 2010

Background: Thanks to a successful voluntary vaccination programme, measles, mumps and rubella are rare diseases in Sweden. Coverage among children 18 mo of age has been 99%, but the measles, mumps and rubella vaccination (MMR) has increasingly been questioned among parents. Aim: To study reasons why parents choose not to vaccinate their child against measles, mumps and rubella, and their opinions on vaccines and the diseases themselves. A secondary objective was to compare coverage at 18 mo of age based on parental report with the national statistics based on patient charts. Methods: The official statistics were compared with patient charts for two birth cohorts in the city of Göteborg, Sweden. Out of these children born in 1995 and 1996, 300 unvaccinated and vaccinated children were identified. Their parents received a postal questionnaire assessing the parent's views on vaccines and childhood diseases. Results: The documented vaccine coverage in this study was higher in 1995 and 1996 than official statistics indicated. The major reason, for both groups, for accepting respectively declining vaccination was strengthening the child's immune system. Parents with children unvaccinated against MMR were also more likely to have declined vaccination against diphtheria, polio, tetanus, Haemophilus influenzae and pertussis. One‐third of the parents with a child unvaccinated against MMR had not yet made their final decision 3 y after the vaccine offer. Few parents, both with vaccinated and unvaccinated children, had acquired vaccine information from the Internet. Both groups believed that insufficient time was allocated for vaccine information and discussion at the Child Health Centre. Conclusion: Our study indicates that official statistics on MMR vaccination uptake underestimate the number of vaccinated children. Vaccine safety is a major concern for many parents and needs to be addressed by healthcare professionals at institutions offering paediatric vaccinations.
Children conceived after intracytoplasmic sperm injection (ICSI): is there a role for the paediatrician?
Authors: Mau C , Juul A , Main KM , Loft A 
Published: August 2010

Aim: The aim of the study was to evaluate current medical knowledge about children born after intracytoplasmic sperm injection (ICSI) with respect to congenital malformations, chromosome abnormalities and postnatal growth. Results: The total malformation rate in children conceived after ICSI was comparable to the background population in nine of the 11 articles studied. In two of the studies, a significant increase in congenital malformations was found. More specifically, children born after ICSI appear to have a higher risk of urogenital malformations, especially hypospadias, which may be related to paternal subfertility. There is insufficient knowledge about chromosomal or genetic anomalies and auxological data in children born after ICSI. The methodological approach to follow‐up the children was inconsistent, as the clinical examinations were not done with standardized ascertainment. Conclusion: Paediatricians and obstetricians should collaborate with fertility clinics to obtain valid longitudinal observations with respect to congenital malformations, neurological development, growth, pubertal maturation, fertility and morbidity in children conceived by ICSI.
Rehospitalization of very preterm infants
Authors: Kollée LAA 
Published: August 2010

Rehospitalization rates of very preterm infants because of reasons that are related to neonatal morbidity states can be decreased with further improvement of neonatal intensive care provided. Conclusion: Analysis of rehospitalization data should be included in follow‐up programmes as a contribution to the development of strategies to improve neonatal care and the ultimate outcome for very‐low‐birthweight infants.
A cohort study of term infants from Vilnius, Lithuania: feeding patterns
Authors: Vingraite J , Bartkeviciute R , Michaelsen KF 
Published: August 2010

Aim: To present infant feeding patterns and to relate these to selected biological and social factors. Methods: One hundred and ninety‐two infants born at four delivery departments were followed prospectively from birth to 12 mo of age. Their parents were asked to tick weekly if the infant received items on a list of the most common infant foods and drinks, including breast milk. Results: All infants started breastfeeding. Median duration of exclusive breastfeeding was 0.5 mo, and 3.75 mo for “any breastfeeding”. Mothers who were older (>25y), better educated (>11 y) and non‐smokers breastfed significantly longer (median 4 mo). Median introduction of cow's milk was 8 (range 2–12) mo. At the age of 12 mo, 78% of infants received cow's milk and 58% of infants received cow's milk as the sole source of milk. Mothers who were younger (<21 y) and less educated (<12y) introduced cow's milk significantly earlier. Mean (SD) start of solids was 3.4 (1.0) mo. Longer duration of breastfeeding was the only factor significantly associated with the later start of solids. Ninety‐two percent of infants were introduced to fresh cheese before 12 mo. Additional liquids were widely given both to breastfed and non‐breastfed infants. Conclusions: Compliance with the current infant feeding recommendations is not sufficient. Breastfeeding rates are low. Use of high‐protein products is widespread. More effort should be made to educate young, less educated and smoking mothers.
Impulse control, working memory and other executive functions in preterm children when starting school
Authors: Böhm B , Smedler A‐C , Forssberg H 
Published: August 2010

Aim: The aim of this study was to explore whether children born preterm have deficient executive functions (EF) in comparison with children born at full term, and, if so, whether this is dependent on inferior intelligence scores and can be correlated to specific neonatal risk factors and gender.Methods: In a population‐based study, the executive functions of 182 preterm children (birthweight less than 1500 g, VLBW) and 125 controls from the Stockholm Neonatal Project were assessed at 5± y with a neuropsychological test battery (Nepsy 1990).Results: The controls surpassed the VLBW children on tests of executive functions (EF), even after controlling for intelligence (IQ); a necessary correction since there were significant correlations between measures of EF and IQ. EF was associated with retinopathy of prematurity (ROP), and with visual impairment as a whole. In both groups, girls surpassed boys on tests of executive functions.Conclusion: We conclude that it is possible to analyse executive functions already at preschool age. Preterm children are at risk of having subnormal levels of executive functioning, even though their general IQ is normal.
Factors of early infancy and recurrent use of antibiotic therapy
Authors: Louhi‐Pirkanniemi K , Rautava P , Aromaa M , Ojanlatva A , Mertsola J , Helenius H , Sillanpää M 
Published: August 2010

Aim: To analyse the role of early infant‐related, parent‐related, family functioning and social relation factors during the infant's first 3 mo of life and their associations with later recurrent treatments with antibiotics. Methods: In an unselected population‐based study, parents expecting their first child were followed from pregnancy until the infant was 18 mo of age. Informed consent to participate was obtained from 1443 women expecting their first child and their spouses. The parents of 817 children reported the number of preceding antibiotic treatments at two times (when the child was 9 and 18 mo old). The outcome measure was the number of antibiotic treatments (options: none, 1–5, ±6). The factors associated with later use of antibiotics were collected during the first 3 mo of the infant's life. The variable factors included infant‐related, parent‐related, family functioning and social relation factors. Results: The final regression analysis showed the potent factors associated with recurrent use of antibiotics: male gender (OR 2.8, 95% CI: 1.6–4.8), frequent physician consultations in early infancy (OR 3.1, 95% CI: 1.8–5.3) and the father's need for outside support (OR 2.2, 95% CI: 1.3–3.8). Conclusions: In addition to early infant‐related medical factors, family factors may be associated with frequent medical consultations and the decision to administer antibiotics to the infant. In the prevention of antibiotic overuse, social and psychological factors should be considered.
Respiratory outcome in school‐aged, very‐low‐birth‐weight children in the surfactant era
Authors: Korhonen P , Laitinen J , HyoUdynmaa E , Tammela O 
Published: August 2010

Aim. To assess respiratory outcome and its predictors during the surfactant era in very‐low‐birth‐weight (VLBW, birth weight <1500g) schoolchildren with and without bronchopulmonary dysplasia (BPD). Methods. At 7‐8 years of age, 34 VLBW children with BPD diagnosed at a postnatal age of 28 d underwent flow‐volume spirometry, metacholine challenge, bronchodilatation test, whole body plethysmography and diffusion capacity measurement. Fourteen of them had not recovered from BPD by a corrected gestational age of 36 wk (sBPD subgroup). The age‐ and sex‐matched control groups comprised 34 VLBW cases without BPD and 34 term children. Results. Current respiratory symptoms in contact with cold air and/or upon exercise were reported in one‐third of the VLBW children. Only half of the symptomatic VLBW cases without BPD had inhaled medications. Compared with term controls, the BPD cases had lower forced expiratory volume in 1 s (FEV1), higher ratio of residual volume to total lung capacity and higher airway resistance. Lower FEV1 and specific conductance were found in the sBPD subgroup compared to both control groups. Additionally, their vital capacity was lower than in term controls. A higher rate of bronchial hyper‐reactivity and lower diffusion capacity of the lungs were detected in VLBW as against term cases. Low birth weight, long duration of oxygen therapy, low socio‐economic status and exposure to animal dander emerged as predictors of poorer respiratory outcome. Conclusion. In the surfactant era, birth weight, neonatal respiratory morbidity, as well as later environmental factors appear to affect the respiratory outcome of VLBW children. However, careful pulmonary follow‐up of all VLBW children seems to be indicated regardless of the severity of neonatal respiratory problems.
Cytokines in the gastric mucosa of children with Helicobacter pylori infection
Authors: Shimizu T , Haruna H , Ohtsuka Y , Kaneko K , Gupta R , Yamashiro Y 
Published: August 2010

Aim: Few studies have looked at the cytokine profile in gastric mucosa in children with Helicobacter pylori infection. This study investigated cytokines and their effects on histological abnormalities in the gastric mucosa of children with H. pylori infection. Methods: The levels of interferon‐γ (IFN‐γ), interleukin‐4 (IL‐4) and IL‐8 proteins were measured in biopsy specimens from the gastric antrum and corpus of children with H. pylori infection, and related to inflammatory cell infiltrations. Results: The antral and corporal mucosal levels of IFN‐γ and IL‐8 proteins were significantly higher in children with H. pylori infection than in uninfected children, but there was no such difference in the levels of IL‐4 protein. The antral mucosal level of IL‐8 protein was significantly higher than the corporal mucosal level of IL‐8 protein in the infected children. Inflammatory cell infiltration was significantly higher in the infected children than in the uninfected children, but there were no significant correlations between mucosal cytokine levels and inflammatory cell infiltrations. Conclusion: The results suggest that the predominant Th1 cytokine response and enhanced IL‐8 production in the mucosa may be involved in the gastric inflammation seen in children infected with H. pylori, as well as in adult patients.
Association between low Apgar score and neonatal cholestasis
Authors: Fischler B , Pettersson M , Hjern A , Nemeth A 
Published: August 2010

Aim: To investigate the association between low Apgar score and the development of cholestasis. Methods: Seventy‐seven cholestatic infants, all referred to our tertiary centre and born between 1987 and 1996 were studied. Twenty‐eight patients had biliary atresia (BA), 36 had various intra‐hepatic disorders and for 13 patients the aetiology of the cholestasis was unknown. Data on gestational age, mode of delivery, Apgar score and birthweight for the cholestatic infants and 1 118 270 control subjects born during the same time period were obtained from the Swedish Medical Birth Registry. If the Apgar score of the cholestatic patient was <7 at 1 min and/or <9 at 5 min and/or <9 at 10 min of age the available medical records were reviewed for signs of neonatal distress. Results: Five cholestatic patients, all of them premature, fulfilled the Apgar criteria. For two of them the low Apgar score and need for immediate resuscitation were explained by major surgical problems. The other three patients, two with biliary atresia (BA) and one with Alagille syndrome, had clinical signs of neonatal distress. The incidence of low Apgar score in BA patients was 7% and in cholestatic patients without known aetiology 0%, neither figure differing significantly from that of the of the control group (2.6 %). Conclusion: Low Apgar score is not more common in any of the cholestatic groups than in the general Swedish population of newborns. We suggest that aetiological associations other than low Apgar score need to be considered in infants with cholestasis of unknown cause.
Human immunodeficiency virus infection, diarrheal disease and sociodemographic predictors of child growth
Authors: Villamor E , Fataki MR , Bosch RJ , Mbise RL , Fawzi WW 
Published: August 2010

Aim: To compare growth patterns between human immunodeficiency virus (HIV)‐infected and ‐uninfected preschool children. To examine the associations between diarrheal and respiratory infections, sociodemographic factors and growth. Methods: A longitudinal study was conducted among 524 children who were 6‐60 mo of age at recruitment. Information on sociodemographic characteristics was collected at baseline from the caregiver. Hemoglobin, malaria infection and HIV status of the children were assessed from a blood sample. Monthly height (length if >24 mo) and weight measurements were obtained, and clinical assessments carried out, during an average 12 mo follow‐up period. Yearly increments in height and weight were compared by HIV status, incidence of diarrhea and respiratory infections, and levels of sociodemographic variables. Results: After adjusting for maternal education, anemia and vitamin A supplementation, HIV infection was related to 2.8 cm [95% confidence interval (95% CI) 0.6, 5.0] and 1.3 kg (95% CI 0.0, 2.5) lower yearly length and weight gains, respectively, in children who were between 6 and 11 mo old at baseline. Among children who were 12‐23 mo old at recruitment, HIV infection was associated with 0.6 kg (95% CI 0.1, 1.0) less yearly weight gain. HIV infection was not related to linear or ponderal growth in children ≤24 mo old. Maternal illiteracy, severe child anemia and episodes of acute diarrhea were additional risk factors for growth delay in length. Conclusion: HIV infection is associated with linear and ponderal growth retardation in children aged >24 mo. Additional predictors of linear growth retardation include preventable conditions such as poor maternal education, child anemia and diarrheal disease.