bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical value of a single postnatal lactate measurement after intrapartum asphyxia
Authors: da Silva S , Hennebert N , Denis R , Wayenberg J‐L 
Published: August 2010

Our aim was to compare the respective values of base deficit and lactate in birth asphyxia. Methods: Base deficit and lactate levels were measured from radial artery blood samples taken at 30min of life in 115 term newborns suspected as having been asphyxiated during labour. Both base deficit and lactate levels were compared between patients who further developed moderate or severe encephalopathy and those who experienced no or only mild encephalopathy. Receiver operating characteristics curves and clinical values of both indicators were computed. Results: The correlation between base deficit and lactate was significant (r2= 0.51, p < 0.0001). Both indicators were significantly associated with neonatal outcome. Lactacidaemia lower than 5 mmol/l and/or base deficit level lower than 10 mEq/l were not followed by neurological complications. Plasma lactate concentration greater than 9 mmol/l was associated with moderate or severe encephalopathy with a sensitivity of 84% and a specificity of 67%. Base deficit and lactate had similar clinical values.Conclusions: Base deficit and lactate measurements in arterial blood at 30 min of life are equally valuable in assessing the severity of birth asphyxia.
Overcoming surfactant inhibition with polymers
Authors: Dargaville PA , Morley CJ 
Published: August 2010

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium‐derived free fatty acids).Recent data suggest that addition of non‐ionic polymers such as dextrano and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near‐complete restoration of surfactant function. The anti‐inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.
The role of the Swedish Child Health Services in breastfeeding promotion
Authors: Nyqvist K Hedberg , Kylberg E 
Published: August 2010

Sweden has one of the highest breastfeeding incidence and duration rates among industrialized countries. Although the Child Health Services offer breastfeeding support to all mothers, there are geographical differences in breastfeeding frequency at different ages. The aims of this study were to describe the present activities in the Child Health Services regarding breastfeeding promotion and to find research evidence regarding interventions. Thirty‐three out of 42 healthcare districts replied to a questionnaire. Differences were found in the transfer of responsibility for newborn infants from hospital to Child Health Centres, criteria for and timing of home visits and recommendations regarding introduction of supplementary food and breastfeeding education for parents and professionals. There were also regional differences in breastfeeding statistics and follow‐up periods.The following recommendations were made on the basis of the survey and relevant literature: transfer of responsibility for newborn infants must guarantee follow‐up of all mother‐infant pairs; uniform breastfeeding assessment and documentation must be established; all mother‐infant pairs must be offered early home visits, continued on a regular basis by health visitors; drop‐in consultations must be established; a telephone hotline must be set up; for preventive purposes, growth charts must be used based on breastfed infants; evidence‐based guidelines for the introduction of other foods must be followed; information must be provided in parent groups; breastfeeding statistics must use WHO definitions; polyclinics must be available for service to mothers/infants after early discharge and as resources for Child Health Centres; Child and Maternal Health Centres must collaborate; quality assurance programs must be established; breastfeeding courses must be offered in the under‐ and postgraduate training of professionals; compulsory in‐service education must be offered; lactation consultant training must be offered at the university level; and lactation consultant positions must be established.
Weight loss and growth velocity in obese children after very low calorie diet, exercise, and behavior modification
Authors: Sothern MS , Udall JN , Suskind RM , Vargas A , Blecker U 
Published: August 2010

The prevalence of obesity in American youth is increasing and treatment of the condition is difficult. We have developed a multi‐disciplinary weight reduction program that extends over 1 y and includes a very low‐calorie diet (VLCD) followed by a hypocaloric diet, exercise, and behavior modification. Based on data collected at baseline, at the end of the acute intervention phase (10–20 wk), and at 1‐y evaluation, we assessed the efficacy of this outpatient weight reduction program in treating obese children and adolescents in a follow‐up of a series of cases. Furthermore, we examined the impact of the approach on growth velocity and maintenance of weight loss at 1 y. Fifty‐six overweight children (aged 7–17 y) were recruited during a period of 18 mo to participate in the weight management program; 52 (93%) completed the acute phase of treatment and 35 (62.5%) successfully completed the I‐y program. There was a significant decrease in body weight and body fat, as assessed by weight determinations and skinfold measurements 0, < 0.0001; results not corrected for age). The body mass index for the 35 individuals who completed the 1‐y program decreased significantly from 32.7 on entry to 28.72 at 1 y (p < 0.0001; results not corrected for age). Conclusion: We conclude that a multidisciplinary weight reduction program that combines a VLCD, followed by a balanced hypocaloric diet, with a moderate‐intensity progressive exercise program and behavior modification is an effective means for weight reduction in obese children and adolescents.
Prediction of hyperbilirubinaemia in the healthy term newborn
Authors: Carbonell X , Botet F , Figueras J , Riu‐Godó A 
Published: August 2010

The aim is to establish the correlation between transcutaneous bilirubin (TCB) and serum bilirubin (TSB) and its predictive value for significant hyperbilirubinaemia ≫290 mcmol/L (17mg/dL). We studied a total of 2004 healthy full‐term newborns, weight 3.230g ± 491g; 90% received breast milk. The study was performed in two phases. In the first phase (610 newborns), the following tests were carried out: hematocrit and bilirubin in umbilical cord blood; TCB at 24 h, 48 h and between 60 h and 96 h at the forehead and over the sternum; TSB was measured along with this last test. In the second phase (1394 newborns), the predictive value of TCB and TSB was validated. The incidence of bilirubin >290 mcmol/L was 2.95% and 3.2%. The correlation between TSB and TCB is high (n= 996; r = 0.92; y = 5.916 + 0.804x; p < 0.000). There was a better correlation between TCB and TSB with sternal compared to forehead determination (< 24 h: 0.81 vs 0.77; 24–48 h: 0.887 vs 0.83; and >48 h: 0.94 vs 0.83). The study showed the scant sensitivity of umbilical cord blood bilirubin and good predictive value at 24 h of TSB > 102 mcmol/L (6mg/dL) and at 48 h of TSB > 154 mcmol/L (9mg/dL) and TCB > 13 (equivalent to 154 mcmol/L). Conclusion: There is a good correlation between TCB and TSB. In infants with TSB 102 mcmol/L at 24 h or TSB > 154 mcmol/L or transcutaneous readings > 13 h at 48 h, a TSB test must be performed after 48 h of life.
Significance of clinical risk factors of cystic periventricular leukomalacia in infants with different birthweights
Authors: Kubota H , Ohsone Y , Oka F , Sueyoshi T , Takanashi J , Kohno Y 
Published: August 2010

Fifteen appropriate‐for‐date premature low‐birthweight infants with cystic periventricular leukomalacia (PVL) were studied. The infants were stratified into three birthweight groups: less than 1000 g, 1000 g and greater but less than 1500 g, and 1500 g or greater. Reported and new risk factors for PVL were compared with control patients for all patients and each birthweight group. Hypocarbia was significantly related to cystic PVL, especially in infants with birthweight 1000 g or greater (p < 0.03). Sensitivity to hypocarbia might be decreased in infants with birthweight less than 1000 g due to therapy or prematurity. In the group with birthweight less than 1000 g, the proportion of cystic PVL infants on continuous intra‐arterial blood‐pressure monitoring tended to be lower than the controls, with an almost significant difference (p= 0.05). The duration of tocolysis was significantly longer in the cystic PVL infants than in the controls when the birthweight was greater than 1500 g (p < 0.04). For some risk factors, a significant difference or a tendency of difference was demonstrated only after stratifying the birthweight. For others, the difference became insignificant after stratification. Assessing risk factors after stratifying by birthweight or degree of prematurity is therefore useful. Conclusion: The results suggest that hypocarbia should be avoided to prevent cystic PVL, especially in infants with birthweight of 1000 g or greater, continuous intra‐arterial blood‐pressure monitoring may be important in infants with birthweight less than 1000 g, and fetal status should be monitored carefully when the duration of tocolysis is prolonged, especially in infants with birthweight of 1500 g or more.
A randomized double‐blind, placebo‐controlled trial of the EMLA® patch for the reduction of pain associated with intramuscular injection in four to six‐year‐old children
Authors: Cassidy KL , Reid GJ , McGrath PJ , Smith DJ , Brown TL , Finley GA 
Published: August 2010

The effectiveness of a eutectic mixture lidocaine‐prilocaine topical anaesthetic cream (EMLA®) patch compared with a placebo patch in the reduction of pain associated with intramuscular immunization was evaluated. As part of the study, 161 children (aged 4‐6‐y) undergoing routine diphtheria, pertussis, tetanus and polio (DPTP) immunization in five urban and five rural private office settings were randomly assigned to an EMLA® patch (n= 83) or a placebo patch control group (n= 78). Pain measurements included: child's self‐report on a Faces Pain Scale; facial action on the Child Facial Coding System; the Children's Hospital of Eastern Ontario Pain Scale and parent and technician ratings on a Visual Analogue Scale. Parents also rated their own and their child's immunization‐related anxiety on a Visual Analogue Scale. The EMLA® patch group had significantly less pain on all four pain measures compared with the placebo group. Of the children in the placebo group, 43% had clinically significant pain, compared with 17% of children in the EMLA® patch group. No severe adverse symptoms occurred as a result of either EMLA® or placebo patch application. Conclusion: The EMLA® patch reduced immunization pain in 4 to 6‐y‐old children during needle injection.
Urinary excretion of free cysteine in critically ill neonates
Authors: Cambonie G , Bellet H , Houdon L , Vallat C , El Younsi M , Vergnes C 
Published: August 2010

In preliminary observations, significant amounts of free cysteine, a neurotoxic amino acid, were noted in the urine of asphyxiated or septic‐shocked neonates. The present study was conducted to determine whether free urinary cysteine was elevated in these critically ill neonates compared with a control group, and to assess the clinical significance of this generation. Free cysteine was measured in the urine of newborn infants with perinatal asphyxia (n= 16) or neonatal sepsis (n= 14) and the urine of a control group (n= 10) by ion‐exchange chromatography. Relationships between cysteine levels and the clinical severity, sulfite supply and neurological outcome of the patients were then studied. Urinary cysteine was 27.6 (15‐49) mmol mol−1creatinine for the patients but was not detectable in the control group. Cysteine levels were correlated with the severity of neonatal septic shock but not with the grade of perinatal asphyxia and did not have a specific influence on the neurological outcome of these patients. The correlation between cysteine level and the severity of neonatal septic shock was indirect and probably linked to higher sulfite administration in this population.Conclusion: The mean daily supply of sulfites is high in critically ill neonates, mainly originating from dopamine and generating significant amounts of cysteine. Although a worsening effect attributable to cysteine on the neurological outcome of the patients could not be demonstrated, the appropriateness of cryptic administration of sulfites by way of drug excipients is called into question.
A new congenital myopathy in a Norwegian family
Authors: Aurivillius M , Lindal S 
Published: August 2010

A 6‐y‐old boy presented with a mild, and apparently non‐progressive, congenital myopathy, primarily affecting explosive movements such as running and jumping. Five other cases, spanning four generations, were identified in his family. A dominant inheritance pattern was suggested. Quadriceps muscle histology showed a selective type II fibre atrophy, which is otherwise considered a non‐specific change associated with a number of conditions. Conclusion: A Norwegian boy with an inherited muscle weakness is presented. Based on clinical and laboratory investigations, and in light of the inheritance pattern, a previously undescribed congenital myopathy is suggested.
Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures
Authors: Oostenbrink R , Moons KGM , Donders ART , Grobbee DE , Moll HA 
Published: August 2010

Physicians often have to perform a lumbar puncture to ascertain the diagnosis in patients with meningeal signs, because of the serious consequences of missing bacterial meningitis The aim of this study was to derive and validate a clinical rule to predict bacterial meningitis in children with meningeal signs, to guide decisions on the performance of lumbar punctures. Information was collected from records of patients (aged 1 mo to 15 y) consulting the emergency department of the Sophia Children's Hospital between 1988 and 1998 with meningeal signs. Bacterial meningitis was defined as cerebrospinal fluid (CSF) leucocyte count >5 cells μl−1 with a positive bacterial culture of CSF or blood. The diagnostic value of predictors was judged using multivariate logistic modelling and area under the receiver operating characteristic curves (ROC area). In the derivation set (286 patients, years 1988–1995) the duration of the main complaint, vomiting, meningeal irritation, cyanosis, petechiae and disturbed consciousness were independent clinical predictors of bacterial meningitis. The ROC area of this model was 0.92. The only independent predictor from subsequent laboratory tests was the serum C‐reactive protein concentration, increasing the ROC area to 0.95. Without missing a single case, this final model identified 99 patients (35%) without bacterial meningitis. Validation on 74 consecutive patients in 3 subsequent years (1996–1998) yielded similar results. Conclusion: This prediction rule identifies about 35% of the patients with meningeal signs in whom a lumbar puncture can be withheld without missing a single case of bacterial meningitis. For the individual patient this prediction rule is valuable in deciding whether or not to perform a lumbar puncture.
Activation of the coagulation system occurs within rather than outside cutaneous haemangiomas
Authors: Antovic J , Bakic M , Milicevic R , Gojkovic G , Blombäck M 
Published: August 2010

Haemangiomas are the commonest tumours of infancy. They can become even more serious if followed by consumption coagulopathy and even life‐threatening in cases of Kasabach–Merritt syndrome, with thrombocytopenia and haemorrhage. Data exist concerning systemic coagulation abnormalities in children with haemangiomas but to our knowledge there are no data on local consumption coagulopathy in haemangiomaper se.We examined blood coagulation and fibrinolysis parameters in blood withdrawn from haemangioma blood vessels and blood withdrawn from the systemic vein in 14 children with cutaneous haemangiomas (3M, 11F; age range 3 mo to 10 y). Compared with controls, significant decreases in fibrinogen levels, FVII activity, antithrombin and plasmin inhibitor levels and increases in international normalized ratio (INR) and D‐dimer levels were observed in the blood samples withdrawn directly from haemangioma blood vessels. Fibrinogen and antithrombin levels in samples withdrawn from systemic veins were reduced in relation to control values whilst INR values increased, but within normal ranges. D‐dimer levels were increased in peripheral blood. The fibrinogen level was significantly lower and the INR and D‐dimer levels were significantly higher in blood samples from haemangiomas compared to systemic blood. Clinical signs of systemic disseminated intravascular coagulation were not observed.Conclusions: Our results suggest a strong local activation and local consumption coagulopathy in haemangioma, along with less conspicuous but observable systemic changes in coagulation and fibrinolysis parameters, although without signs of consumptive coagulopathy. These systemic changes could be a reflection of intra‐lesion coagulation activation although there is no evidence to suggest truly systemic disseminated intravascular coagulation.
Antigranulocyte monoclonal antibody immunoscintigraphy in inflammatory bowel disease in children and young adolescents
Authors: Bruno I , Martelossi S , Geatti O , Maggiore G , Guastalla P , Povolato M , Ventura A 
Published: August 2010

Aim: Diagnostic delay for inflammatory bowel disease (IBD) is frequent, especially in paediatric patients. Scintigraphy with labelled leucocytes has been proposed as a very sensitive diagnostic tool for detecting bowel inflammation. The aim of this study was to evaluate the sensitivity and specificity of immunoscintigraphy in the diagnosis and follow‐up of children with IBD and to compare this technique with other diagnostic techniques. Methods: Sixty‐six children with histologically confirmed IBD were enrolled in the study. Twenty‐one children in whom IBD was suspected but subsequently not confirmed were used as controls. A total of 138 immunoscintigraphies were performed using 99mTechnetium‐labelled monoclonal anti‐granulocyte antibodies. Immunoscintigraphy was also compared with other diagnostic techniques. Results: Overall sensitivity of monoclonal antibody immunoscintigraphy (MoAb‐IS) in patients with clinically active disease was 94% for Crohn's disease (CD) and 85% for ulcerative colitis (UC). Ultrasonography, endoscopy and radiology were carried out at the same time in 29 patients with CD and in 6 patients with UC: sensitivity of IS was 90% compared with 76% of colonoscopy, 75% for enemas, and 55% for sonography. IS was negative (specificity) in 24% of patients with CD and in 67% of patients with UC during remission, and in 64% of controls with other causes of intestinal inflammation. Diagnostic delay was significantly shorter when compared with a historical cohort of patients. Conclusion: Immunoscintigraphy is a highly sensitive detector of intestinal inflammation in young patients with IBD and can be useful for reducing diagnostic delay. However, its specificity is low and all positive cases must be confirmed histologically.
Developmental assessment of preterm and term children at 18 months: reproducibility and validity of a postal questionnaire to parents
Authors: Bortolus R , Parazzini F , Trevisanuto D , Cipriani S , Ferrarese P , Zanardo V ,   Gruppo di Studio Metodologie nei Follow‐up Pediatrici
Published: August 2010

Aim: To examine the degree of agreement between the paediatrician's assessment and parental reporting of infants’development using a postal questionnaire. Methods: The developmental status of 241 infants in the charge of 9 community paediatricians or discharged from one Neonatal Intensive Care Unit (NICU) was assessed by their parents 18 mo after delivery, using a postal questionnaire regarding child's height, weight, respiratory, hearing and vision problems, and items taken mainly from the Griffiths’Developmental Scales. At this age, infants were seen by the community or NICU paediatricians, for a complete physical and neurodevelopmental examination. Results: The mean agreement on items regarding developmental areas between parents and paediatricians was 93.0%. In general, parents and professionals agreed on items describing gross motor behaviour (k from 0.39 to 0.83) and disagreed on individual questions describing language/ relational behaviour (k from 0 to 0.38). A 97.9% level of agreement was found for hearing status (k= 0), and 96.2% for assessment of vision (k= 0.29), whereas the level of agreement ranged from 43.2% to 86.2% (k from 0 to 0.15) for the three questions describing respiratory problems. The mean weight and height assessments by paediatricians and parents of infants at 18 mo of age were similar. Conclusions: Further improvement of the questionnaire is needed, but our findings suggest that this methodology can be considered for use in comparing large cohorts of infants included in randomized clinical trials.
Follow‐up into young adulthood after cardiopulmonary resuscitation in term and near‐term newborn infants. I. Educational achievements and social adjustment
Authors: Kjellmer I , Beijer E , Carlsson G , Hrbek A , Viggedal G 
Published: August 2010

Aim: Long‐term sequelae after perinatal asphyxia have generally been assessed at preschool or school age. The aim of the study was to confirm the hypothesis that there could be impairment of cognitive and memory functions that does not become apparent until education and adult life impose special demands. Methods: Seventy‐one term or near‐term newborns in need of cardiopulmonary resuscitation because of presumed perinatal asphyxia were investigated with evoked EEG potentials during the first week of life and were investigated at a follow‐up clinic until 18 mo of age. At that time 12 subjects showed signs of neuro‐developmental impairment. The remaining 59 were considered healthy. They were contacted at young adult age and given a questionnaire containing questions about type of education, need for extra support at school, present activity/employment, living conditions, spare‐time activities and self‐estimation of health. Results: Thirty‐five control subjects were approached at the same time. From the group that was resuscitated at birth, 53 questionnaires were returned and 30 from the control group. Although the resuscitated subjects had signs of both encephalopathy and pathologic evoked responses during their neonatal period, the questionnaire revealed that they had coped with school equally as well as their peers, that the rate of entering university studies was the same and that living conditions were similar between the groups. Conclusion: These individuals who were resuscitated at birth and who demonstrated various degrees of neonatal encephalopathy suffered either brain injury that could be diagnosed at 18 mo of age or managed as well as their non‐resuscitated peers in terms of educational achievement and social adjustment at young adult age.