bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of three treatment schedules in severe meconium aspiration syndrome
Authors: Salvia‐Roigés MD , Carbonell‐Estrany X , Figueras‐Aloy J , Rodríguez‐Miguélez JM 
Published: August 2010

Aim: To compare three different schedules in severe meconium aspiration syndrome (MAS) treatment: standard, bronchoalveolar lavage (BAL) with diluted surfactant, and diluted surfactant BAL plus a single early dexamethasone dose. Methods: Twenty‐four full‐term newborns with severe MAS (needing mechanical ventilation and with oxygenation index ± 15) were divided into three groups: group I (historical control group; n= 6) treated with standard therapy; group II (n= 7) treated in the first hours of life with one BAL using diluted surfactant (beractant 5 mg/mL) in a volume of 15 mL/kg in four aliquots; and group III (n = 11) treated with one diluted surfactant BAL and a previous single dose of intravenous dexamethasone (0.5 mg/kg) Results: At 12h, groups II and III showed a significant improvement in oxygenation index (OI) compared with group I (14.7% and 27.0% vs – 19.6% respectively; p= 0.012). Group III also showed a significantly lower OI than group I at 24 h (63.6% vs – 27.9%) and at 48 h (87.1% vs 49.6%). Group III, in comparison to group I, showed a lower FiO2 requirement at 12 h (0.66 vs 1), at 24 h (0.4 vs 0.87) and at 48 h (0.35 vs 0.67), and a decrease in the number of days of inhaled nitric oxide administration, mechanical ventilation, oxygen therapy and hospitalisation period. All patients from groups II and III survived and none developed pneumothorax or respiratory infections. Conclusion: Diluted surfactant BAL in the first hours of life combined with an intravenous single dose of dexamethasone may be an effective treatment for severe MAS.
Diagnosis and management of gastro‐oesophageal reflux in preterm infants in neonatal intensive care units
Authors: Dhillon AS , Ewer AK 
Published: August 2010

Aim: There is relatively little published information regarding gastro‐oesophageal reflux (GOR) in preterm infants, therefore the aim of this study was to elucidate the incidence of GOR and management regimes employed for this condition in major neonatal intensive care units (NICUs). Methods: A standard questionnaire was sent to consultants in 77 level II (or secondary) and III (or tertiary) NICUs. Results: Seventy‐eight percent of consultants responded. Of babies born in these units, 40% were less than 34 wk gestational age and the estimated incidence of GOR in this group was 22%. GOR was diagnosed on a clinical basis alone in 42% of units, 8% used clinical features and/or investigations, and 50% used clinical features plus investigations and/or therapeutic trials. Intra‐oesophageal pH monitoring was available in 93% of units but used regularly in only 32% of suspected cases. Common treatment strategies for diagnosed GOR included non‐drug options—body positioning (98%) and placement on a slope (96%); and drugs—H2‐receptor antagonists (100%), feed thickeners (98%), antacids (96%), prokinetic agents (79%), proton‐pump inhibitors (65%) and dopamine‐receptor antagonists (53%). However, the frequency with which all of these treatments were used varied widely between units. Surgery was required in only 1% of cases. Conclusions: GOR is perceived to be a common condition in preterm infants but the lack of published evidence relating to the management of GOR in preterm infants is reflected in the wide variation in diagnostic and treatment strategies used in major NICUs. It is clear that randomized, controlled trials to evaluate appropriate and effective treatments are needed.
Protective effect of breastfeeding against urinary tract infection
Authors: Mårild S , Hansson S , Jodal U , Odén A , Svedberg K 
Published: August 2010

Aim: To assess the possible protective effect of exclusive breastfeeding against first‐time febrile urinary tract infection (UTI) in children. Methods: Two children's hospitals and local child health centres in the Göteborg area, Sweden, participated in a prospective case‐control study. In total, 200 consecutive cases (89M, 11 1F), aged 0–6 y, presenting with first‐time febrile UTI were enrolled. The mean ± SD age was 0.98 ± 1.15y. As control subjects, 336 children (147M, 189F) were recruited from the child health centre of the case, matched for age and gender and included consecutively for each case during the first days after diagnosis. The duration of exclusive breastfeeding was obtained from the case and controls by a standardized procedure. Results: Ongoing exclusive breastfeeding gave a significantly lower risk of infection. A longer duration of breastfeeding gave a lower risk of infection after weaning, indicating a long‐term mechanism. The protective role of breastfeeding was strongest directly after birth, then decreased until 7 mo of age, after which age no effect was demonstrated. Conclusion: A protective role of breastfeeding against UTI was demonstrated. The study provides statistical support to the view that breast milk is a part of the natural defence against UTI.
Serum procalcitonin and C‐reactive protein in children with diarrhoea of various aetiologies
Authors: Korczowski B , Szybist W 
Published: August 2010

Aim: Procalcitonin (PCT) and C‐reactive protein (CRP) are two acute‐phase reactants with different clinical features. The study aimed to compare the diagnostic value of admission serum PCT and CRP concentrations as indicators of aetiology and intensity of inflammation in children hospitalized with diarrhoea. Methods: Serum PCT and CRP concentrations were determined on admission in 129 children hospitalized with diarrhoea. They were divided into four groups: group A: 37 children with diarrhoea as one of symptoms of ongoing systemic bacterial infection (sepsis/meningitis); group B: 36 children with bacterial enterocolitis; group C: 43 children with rotaviral enterocolitis; and group D: 13 children with active inflammatory bowel disease (IBD). For comparison serum PCT and CRP concentrations were determined in 30 healthy controls. Results: PCT concentration was >0.5 ng ml−1 in all 37 (100%) children with diarrhoea and systemic bacterial infection (mean 18.5 ± 3.2 ng ml−1) and CRP was above 2 mg dl−1 in 33 (89%) of these children (11.7 ± 1.5 mg dl−1). PCT concentration was ± 0.5 ng ml−1 in 22 of 36 (61%) children with bacterial enterocolitis (2.2 ± 0.6 ng ml−1), in 3 of 43 (7%) children with rotaviral infection (0.2 ± 0 ng ml−1) and in 3 of 13 (23%) patients with IBD (0.3 ± 0.1 ng ml−1). CRP value was ± 2 mg dl−1 in 22 (61%) children from group B (5.4 ± 1.0 mg dl−1), in 8 (19%) children from group C (1.3 ± 0.3.mg dl−1) and in 6 (46%) patients from group D (3.3 ± 0.9 mg dl−1). In the control group the PCT (0.1 ± 0.1 ng ml−1) and CRP (0.03 ± 0.1 mg dl−1) levels were low or undetectable. Conclusion: In this study PCT was a more reliable marker than CRP of systemic bacterial infection in children with diarrhoea. PCT was more specific but less sensitive in the differentiation of bacterial and non‐bacterial aetiology of inflammation.
Reports of pain among German children and adolescents: an epidemiological study
Authors: Roth‐Isigkeit A , Thyen U , Raspe HH , Stöven H , Schmucker P 
Published: August 2010

Aim: The aim of this study was to investigate the prevalence of pain and characteristics of pain (frequency, duration, intensity) among children and adolescents and to compare them across different age and gender groups. Methods: 735 children and adolescents aged 10–18 y from schools in the Luebeck region of Germany were surveyed using a modified German version of the self‐completion pain questionnaire of Perquin and co‐workers. Results: 715 out of 735 questionnaires (97.3%) were returned completed. Pain during the preceding 3 mo was reported by 85.3% (n= 610) of the respondent children and adolescents. The prevalence of pain increased with age. The most common complaints were headache (65.6%), abdominal pain (47.7%), limb pain (46.4%) and back pain (38.6%). A pain duration of longer than 3 mo was reported by 45.5% (35.4% for longer than 6mo). Pain once a week or more frequently was reported by 33.7% of children and adolescents. Conclusion: Almost half of the surveyed children and adolescents had suffered complaints for longer than 3 mo. The experience of pain in general and especially pain with a duration of longer than 3 mo is very common in children and adolescents, and requires further attention. Further studies are necessary to investigate the natural course, functional implications and prognosis due to pain complaints in children and adolescents.
Do inhaled steroids differ from cromones in terms of hospital admission rates for asthma in children?
Authors: Korhonen K , Dunder T , Klaukka T , Reijonen TM , Issakoff K , Kiviharju M , Linna O , Remes K , Korppi M 
Published: August 2010

Aim: The aim of the present study was to investigate the characteristics of hospital admissions in two child populations receiving different types of drugs as their regular medication for steady‐state asthma. Methods: Annual data on children aged under 16 y treated for asthma, including consumption of regular medication for asthma, numbers of hospital periods, lengths of hospitalizations and annual proportions of readmissions, were collected using patient‐specific medical records from 1995 to 1999. In the Kuopio province, on average, 35.6–36.7/1000 children were on maintenance for asthma, of which 23% were receiving cromones, 51% were taking inhaled steroids and 26% were treated with cromones plus intermittent steroids. In the Oulu province, the respective prevalence was 32.7–34.9/1000, and the respective proportions were 5%, 93% and 2%. Results: Total and first admissions, as well as hospital days were clearly less in the Oulu province. In the children aged ≥6 y, the average annual total admissions were 0.3/1000 (Oulu) vs 1.2/1000 (Kuopio) (p < 0.001). Similarly, the first admissions were 0.2/1000 vs 1.0/1000 (p < 0.001), proportions of readmissions 6.3% vs 19.3% (p < 0.05), and numbers of hospital days 0.7/1000 vs 3.8/1000 (p < 0.001). The differences were in the same direction, though less prominent, also among children 2–5 y of age. Conclusion: Our results suggest that inhaled steroids are better than cromones in preventing admissions for asthma when two provinces with different practices for maintenance medication of steady‐state asthma were compared.
Pheochromocytoma in childhood: implication for further diagnostic procedures
Authors: Beck O , Fassbender WJ , Beyer P , Kriener S , Neumann HPH , Klingebiel T , Lehrnbecher T 
Published: August 2010

We report on our experience with two patients with pheochromocytoma. One patient underwent surgery of pheochromocytoma at the age of 30 y; 18 y later, medullary thyroid carcinoma (MTC) was detected in his son. Subsequently, multiple endocrine neoplasia (MEN) type 2A was diagnosed by genetic examination in both father and son. Further diagnostic procedures also revealed an MTC in the father. The other patient suffered from bifocal pheochromocytoma of the left suprarenal gland. Diagnostic work‐up revealed papillary thyroid carcinoma, which was also detected in the mother 8 mo later. Whereas a point mutation in SDHB gene was found in the son, no genetic abnormality was detected in the mother. Conclusion: Every pheochromocytoma in childhood warrants further diagnostic work‐up, including genetic examination. In addition, clinical data of patients suffering from pheochromocytoma and papillary thyroid carcinoma should be collected by an international registry, and a joint effort should be undertaken in order to define possible underlying mutated genes in these patients.
Congenital staphylococcal scalded skin syndrome in a premature infant
Authors: Haveman LM , Fleer A , de Vries LS , Gerards LJ 
Published: August 2010

A case of congenital staphylococcal scalded skin syndrome (SSSS) with fatal outcome in a premature infant is reported. An intrauterine infection with Staphylococcus aureus was probably the cause for the fulminant course of the disease. Despite adequate antibiotic treatment, the infant died within 24 h after birth because of respiratory failure. Conclusion: Although rare, infection may occur in the perinatal period and SSSS may present within the first 24 h of life. In this situation, early administering of appropriate antibiotics is essential.
Behavioural outcome of regulatory problems in infancy
Authors: Larsson J‐O 
Published: August 2010

Infant regulatory problems at 3 mo of age and later hyperkinetic problems in childhood were evaluated in a prospective longitudinal study. Conclusion: There was a less favourable long‐term behavioural outcome in children with multiple regulatory problems. However, family adversity clearly outweighed infant regulatory problems as a predictor of hyperkinetic symptoms.
Gastrointestinal manifestations in Henoch‐Schönlein purpura: a review of 261 patients
Authors: Chang W‐L , Yang Y‐H , Lin Y‐T , Chiang B‐L 
Published: August 2010

Aim: Henoch‐Schönlein purpura is an IgA‐mediated autoimmune vasculitis of children. It often presents with symptoms including purpuric rash, abdominal pain, renal involvement or arthritis. Abdominal pain is a frequent symptom in children with HSP and raises the suspicion of intussusception or perforation. We sought to evaluate abdominal pain via stool occult blood and image studies.Methods: A retrospective study of 261 patients diagnosed with Henoch‐Schönlein purpura from December 1991 to December 2001 was conducted. Image studies, including abdominal echo, abdominal CT and panendoscopy, were performed for patients who suffered from abdominal pain.Results: Of the 261 patients, 151 (58%) had abdominal pain, and 46 (17.6%) suffered either overt gastrointestinal bleeding or had positive stool occult blood. Seven patients had gross bloody stools. One acute intussusception and one bowel perforation were noted. One patient suffered from hypovolemic shock due to massive gastrointestinal bleeding. When stool occult blood was 3+ or 4+, the incidence of a positive image finding was high.Conclusion: We found that stool occult blood and image studies may be necessary regarding severe gastrointestinal involvement. Ultrasonography is an important tool when intussusception or bowel perforation is suspected. Monitoring the vital signs is important, especially in patients with massive gastrointestinal bleeding.
Randomized controlled trial of intrapleural streptokinase in empyema thoracis in children
Authors: Singh M , Mathew JL , Chandra S , Katariya S , Kumar L 
Published: August 2010

Aim: To compare intrapleural streptokinase and placebo in paediatric empyema. Methods: Children with empyema greater than stage 5 received intrapleural streptokinase (n= 19) or normal saline (n= 21) along with intercostal drainage. Clinical and serial sonographic outcomes were compared. Results: Although there was no difference in clinical and sonographic outcome, none of the children with stage 7 empyema (multi‐loculated empyema) who received streptokinase developed pleural thickening 30 d later. Conclusion: There is no short‐term clinical benefit of intrapleural streptokinase in paediatric empyema; this therapy may be reserved for those with stage 7 empyema to prevent pleural thickening in the long term.
How do paediatricians communicate with children and parents?
Authors: Wassmer E , Minnaar G , Aal N Abdel , Atkinson M , Gupta E , Yuen S , Rylance G 
Published: August 2010

Aim: The outpatient clinic visit is the major focus of the hospital medical process for most paediatricians, children and parents. The importance of children as active participants in this interaction has been recognized. Our study aims are to describe and assess the components of doctor‐parent‐child communication in the outpatient setting. Methods: Fifty‐one medical paediatric clinic consultations were recorded on audio cassette, and communication was analysed according to quantitative methods. Questionnaires assessed parents' and children's perceptions. Results: Doctors contributed most to the conversation (61%), children only 4%. Behaviour: Doctors' communication was 84% instrumental (e.g. asking questions, giving information or instructions), 13% affective behaviour (expressing concerns and worries) and 3% social (small talk). Parents' communication included giving information (83%), seeking information (13%) and social (4%). The child asked less information (3%) and had more social conversation (19%). Control: Doctors dominated in turn taking (52%). Children took 9% of all turns. Perception: There was no correlation between parents' and children's perception and the informative or affective behaviour of the doctor. Conclusion: Communication is mainly instrumental. Doctors tend to direct the interview. Children's contribution is small. The participation of children needs to be encouraged as part of a patient‐centred approach.
A case of Kawasaki Disease associated with syndrome of inappropriate secretion of antidiuretic hormone
Authors: Mine K , Takaya J , Hasui M , Ikemoto Y , Teraguchi M , Kobayashi Y 
Published: August 2010

Kawasaki disease (KD) is an acute vasculitis of unknown aetiology with varied clinical manifestations. Although coronary arteritis is common in the course of KD, central nervous system involvement is rare. We report a case of KD in an infant who developed convulsions and apnoea during his illness associated with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Conclusion: The possibility of severe hyponatraemia should be anticipated in children with KD. Infants with KD are at risk of SIADH and should be monitored closely for its development.
Transcutaneous bilirubinometry in very low birthweight infants
Authors: Karolyi L , Pohlandt F , Muche R , Franz AR , Mihatsch WA 
Published: August 2010

Aim: To evaluate whether transcutaneous bilirubinometry (TcB) would be a reliable and efficient screening technique for hyperbilirubinaemia in very low birthweight (VLBW, ±1500 g) infants in an intensive care unit setting. Methods: TcB measurements (Minolta Airshield Jaundice Meter JM‐102, Osaka, Japan) were obtained immediately before or within 10min following routine blood sampling for plasma bilirubin concentration measurements in 124 VLBW infants not receiving phototherapy. The relationship between the two techniques was analysed by linear regression analysis. A plasma bilirubin ±150 μmol/1 was defined as hyperbilirubinaemia. The sensitivity and specificity of possible TcB cut‐off readings to detect hyperbilirubinaemia was evaluated. Results: There was a significant correlation between the measurements of both techniques (p < 0.0001, r= 0.68). In the present study, a TcB cut‐off reading of 14 would have reduced the need for plasma bilirubin measurements by 26% without missing true hyperbilirubinaemia. Conclusion: The data suggest that TcB will improve VLBW infant care in an intensive care unit setting by reducing the need for invasive bilirubin concentration measurements.
Extensively and partially hydrolysed preterm formulas in the prevention of allergic diseases in preterm infants: a randomized, double‐blind trial
Authors: Szajewska H , Mrukowicz JZ , Stoiska B , Prochowska A 
Published: August 2010

Aim: A randomized, double‐blind study was conducted to evaluate whether use of protein hydrolysate‐based preterm formulas in infants with an atopic predisposition helps prevent the development of allergic diseases. Methods: Preterm infants (n= 122) with at least one first‐degree relative (parent or sibling) with allergic disease were randomly assigned to receive an extensively or partially hydrolysed preterm formula (intervention groups) or a standard preterm formula until 4 to 5 mo of age. Infants whose parents preferred that they be breastfed received their mothers' fortified breast milk. Results: Intention‐to‐treat analysis showed that the overall incidence of allergic diseases did not significantly differ between groups at both 4–5 and 12 mo of age. However, by 12 mo, use of the extensively hydrolysed versus the standard preterm formula had significantly reduced the risk of atopic dermatitis. At 4–5 and 12 mo, there was a significantly increased risk of non‐acceptance of the extensively hydrolysed formula compared with the other formulas. Conclusions: This study failed to show that extensively or partially hydrolysed preterm formulas in comparison with a standard preterm formula reduced the overall incidence of allergic diseases in infants at high risk for atopic disease. However, use of the extensively hydrolysed compared with a standard preterm formula significantly reduced the incidence of atopic dermatitis observed at 12 mo. Infants who received extensively hydrolysed formulas were at increased risk for intervention discontinuation for any reason, particularly non‐acceptance of the formula. Because of the small number of patients eligible for this analysis, these results should be interpreted with caution.
Expression of neurotrophic factors in cerebrospinal fluid and plasma of children with viral and bacterial meningoencephalitis
Authors: Chiaretti A , Antonelli A , Piastra M , Genovese O , Polidori G , Aloe L 
Published: August 2010

Aim: To evaluate the expression of neurotrophic factors (nerve growth factor (NGF), brain‐derived neurotrophic factor (BDNF), glial‐derived neurotrophic factor (GDNF)) and their association with the clinical‐radiological characteristics and outcome of children with viral and bacterial meningoencephalitis (ME). Methods: Prospective observational clinical study performed on 13 children with ME and 12 controls with non‐inflammatory obstructive hydrocephalus. Neurotrophic factor levels in the cerebro‐spinal fluid (CSF) and plasma were measured using an immunoenzymatic assay. Results: High levels of NGF and BDNF were demonstrated in all patients, while GDNF levels did not undergo significant variations. NGF expression in the CSF was higher in viral ME than in bacterial ME and was correlated with CSF cellularity (particularly mononuclear cells). BDNF expression in the CSF was higher in bacterial ME than in viral ME and was correlated with CSF cellularity and blood platelet count. No relationships were noted between CSF protein or serum C‐reactive protein levels and the expression of neurotrophic factors. Regarding clinical and radiological features, elevated NGF/BDNF levels in the CSF correlated with higher incidence of seizures and prolonged comatose state and with specific radiological lesions. No correlation was found between NGF/BDNF levels and final outcome. Conclusions: The variations in neurotrophic factor levels may reflect an endogenous attempt at neuroprotection against biochemical and molecular changes during both viral and bacterial ME. The expression of these factors is likely to play a neuro‐immunomodulatory or neurosurvival role in ME infections.