To assess tracking of lipid and apolipoproteins from the prepubertal age (baseline, 6-8 years old) to adolescence (follow up, 13-16 years old) in Spanish children.

The sample population included 385 healthy children (179 males and 206 females). Tracking was estimated by correlations between baseline and follow-up levels, multiple regression models in which the follow-up lipid was the dependent variable, and analyzing the percentage of individuals who remained in the same lipid levels status from prepubertal age to adolescence.

Correlations between baseline and follow-up levels for LDL-cholesterol and apoB were stronger in boys, and for HDL-cholesterol and apoA-I stronger in girls. Regression analyses showed that, after adjusting by BMI, baseline LDL-cholesterol and apoB levels explain 23% and 39% of the variation of follow-up LDL-cholesterol and apoB levels respectively in boys, and 13% and 22% respectively in girls. The strength of tracking for LDL-cholesterol and apoB was 79% and 89% respectively in boys and 72% and 82% respectively in girls.

ApoB showed the strongest tracking in both sexes, stronger than for LDL-cholesterol, which supports the importance of determining apoB levels as a marker of dyslipemia in children.

This article is protected by copyright. All rights reserved.

To relate height, weight, and body mass index (BMI) of prepubertal children in Sagamu, Nigeria, to parental socioeconomic class (SEC).

Cross-sectional study of 1606 children aged 5-11 years from 8 public, 8 private primary schools. Height, weight, BMI from 1557 prepubertal children was standardized using two references: US-CDC birth cohorts1929-1974 and Swedish birth cohort 1974.

Children in private schools were taller, and heavier than those in public schools (p<0.0001). Most children (73.2%) belonged to lower SEC,17.6% to middle and 9.2% to upper SEC. Height_SDS, weight_SDS and BMI_SDS increased with increasing parental SEC. Upper SEC children were taller, heavier with higher BMIs than those from lower SEC (p<0.0001). Height_SDS, weight_SDS, BMI_SDS were below ‘0’ in all SEC and gender groups (all p<0.002). Younger children were taller and heavier than the older (p<0.0001).

Fathers/mothers with higher education/occupation had taller, heavier children with higher BMI than other groups. Children in private schools were taller and heavier than children in public schools. Disparities in parental SEC still constrain optimal child growth in Nigeria: Whereas height and weight of children of upper SEC were close to the US-CDC_29-74 reference mean they were still below Swedish₇₄ reference mean representing more optimal growth.

This article is protected by copyright. All rights reserved.

To compare the influence of three different non-pharmacologic interventions on cortical activation, heart rate and peripheral oxygen saturation (SaO₂) after heelstick in preterm infants.

25 preterm infants between 24 0/7 and 32 0/7 weeks of gestational age were randomized to either oral sucrose (S), facilitated tucking (FT) or a combination of the two interventions (SFT) prior to five heelsticks each within the first 14 days of life. SaO₂, heart rate and oxygenation of the somatosensory cortex, measured by near infrared spectroscopy (NIRS) were analyzed.

125 heelsticks were performed. The heart rate increased significantly after heelstick in all three intervention groups (p<0.004 in all groups). The increase was higher in the FT group compared to the other groups (S: p=0.007; SFT: p=0.004). There was no difference among the two groups receiving sucrose (S and SFT) (p=0.87). SaO₂ did not change significantly after heelstick in all intervention groups. NIRS measurements did not show a significant change of the curve but patients in the FT group showed a trend towards higher average oxygenation of the contralateral somatosensory cortex.

Oral sucrose seems to be more effective in reducing reaction to pain than FT. Application of both interventions did not show an additive effect.

This article is protected by copyright. All rights reserved.

Although the body length and weight of an infant are related to head circumference, little research on ASDs has examined these factors. Our study compared the head circumferences of neonates who were later diagnosed with ASD with a control group. Additional comparisons on morphological disproportions at birth included the head circumference-to-height and head circumference-to-weight ratios.

We recruited 422 children with ASD and 153 typically developing children. Head circumference, body length and weight at birth were collected and standardized as percentile scores according to gestational age and gender.

Our results revealed that genuine macrocephaly was significantly higher in children with other pervasive developmental disorders compared with the control group. This difference was not observed with regard to genuine microcephaly. Relative macrocephaly and relative microcephaly were significantly more frequent in children with autism disorder compared to the control group with regard to body length.

The differences in relative macrocephaly and microcephaly, as well as in other parameters, between diagnostic subgroups, suggest that the presence of several neurological mechanisms plays a role in the later expression of different phenotypes. An increased head circumference-to-body length ratio in newborns may be a factor to follow that could be related to ASD.

This article is protected by copyright. All rights reserved.

The aim of this study was to compare the growth of Japanese infants that were exclusively breastfed to those of national references and World Health Organization (WHO) standards.

Mothers, who delivered a normal term baby and had been exclusively breastfeeding for at least 4 months, were enrolled. The lengths, body weights, and head circumferences of 647 children, aged 0 to 24 months, were obtained and compared to national references and WHO standards.

Comparisons of the national references for both length and body weight indicated that breastfed infants were significantly shorter and lighter almost throughout the first 24 months. Conversely, head circumferences of breastfed infants were significantly larger at 1 and 6 months of age in boys and 6 months in girls. Compared to WHO standards, similar trends to the comparisons with national references were found.

There were significant differences identified between the growth of breastfed infants and existing national references and WHO standards.

This article is protected by copyright. All rights reserved.

Exclusive breastfeeding (EBF) for 6 months is recommended for optimal infant health, but the evidence for longer-term impacts is weak. We examined whether randomization to receive EBF counselling (BFC) in rural Bangladeshi women had an impact on childhood growth trajectories and body composition.

In the Maternal and Infant Nutrition Interventions in Matlab trial, 4436 pregnant women were randomized to six equally sized, food and micronutrient groups. Of these, 3214 were randomized during the last trimester of pregnancy to receive either BFC or the usual/standard health message (UHM). Their infants were extensively followed up, with anthropometric measurements between 0 and 54 months and assessment of body composition at 54 months.

The mean duration of EBF in the BFC group was 111 days compared to 76 days in the UHM group (mean difference: 35.0 days, 95% CI 30.6–39.5, p < 0.001). There was no difference in growth trajectories between the BFC and UHM groups and no difference in body composition at 54 months. Children exposed to prenatal multiple micronutrients (vs 60 mg iron and folate) combined with BFC (vs UHM), however, had slower linear growth (mean difference −0.17 SD score, p < 0.01).

Exclusive breastfeeding counselling resulted in neither differential growth trajectories in infancy and childhood, nor body composition differences at 54 months. The combination of prenatal multiple micronutrient supplementation (MMS) and BFC was unfavourable for linear growth during 0–54 months, which raises questions about possible negative effects of MMS.

To evaluate the apparent diffusion coefficient (ADC) values for predicting the long-term neurodevelopmental outcomes of patients with abusive head trauma (AHT).

Apparent diffusion coefficient maps were retrospectively reviewed for 14 patients who presented with AHT at a mean age of 6.7 months (range 1–18 months), and the clinical outcomes of the survivors were based on the Glasgow Outcome Score.

One of 14 infants died, and two were severely disabled. One had mild impairment and four had moderate disability. In the 4 days after admission, the ADC values in all brain regions were strongly associated with a poor neurodevelopmental outcome (p < 0.05): basal ganglia, thalamus, brain stem, corpus callosum, frontal white matter, central white matter, parietal white matter, frontal grey matter, parietal grey matter, cerebellar vermis, cerebellar cortex and mean total brain.

Apparent diffusion coefficient values during the acute phase of AHT were significantly associated with poor long-term neurodevelopmental outcomes.

Indications for post-natal steroids among preterm infants are evolving. The objective of this study was to compare steroid use in 2 cohorts 5 years apart and to document the short- and long-term outcomes of our most recent cohort.

Retrospective chart review of infants born under 28 weeks of gestational age for two cohorts (January 2002-August 2003 and July 2008-March 2010).

Two hundred and fourteen infants were included. More infants received steroids in the later cohort (20% vs 35%, p = 0.021) but survival rates did not improve. There was a shift towards hydrocortisone use (<7% vs 76%) and pulmonary indications (36% vs 61% of courses; p = 0.021). Patients died later (8 days vs 30 days; p = 0.02), with a strong correlation between time of death and total dose of steroids (r = 0.91; p = 0.01). Neurodevelopmental outcomes for patients who received steroids for pulmonary indications were inferior to those for the rest of the cohort (severe adverse outcome 26% vs 4.8%, p = 0.03).

The improvement in short-term respiratory status of ill preterm patients was offset by a disturbing increase in age at death and no improvement in survival rates.

Current American Academy of Pediatrics Guidelines recommended that statins should be considered as a first-line agent in children as early as 8 years of age. The aim of our work is to assess the safety of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors in children with hypercholesterolaemia.

Controlled studies in children show that statin monotherapy is efficacious, well tolerated and safe in the short-time. Unfortunately, these studies have relatively short-term follow-up periods, and therefore, long-term safety remains unclear.

We hypothesized that the fatty acid composition of breast milk can be affected by a smoking habit in the mother. Consequently, this study verified whether maternal smoking modulates, and if so to what extent, the breast milk fatty acid profile.

The study included 20 postpartum women who declared smoking more than five cigarettes daily throughout a period of pregnancy and lactation, and 136 nonsmoking postpartum women. Breast milk samples were collected between the 17th and the 30th day after delivery. The samples were analysed by means of high-resolution gas chromatography for overall content of saturated, monounsaturated and polyunsaturated fatty acids.

Compared with nonsmokers, smokers were characterized by significantly higher relative breast milk contents of fatty acids and monounsaturated fatty acids. Additionally, smokers’ breast milk had higher concentrations of selected saturated fatty acids, monounsaturated fatty acids and polyunsaturated fatty acids. Furthermore, smokers were characterized by significantly lower values of linoleic to arachidonic acid ratio and n-6 to n-3 polyunsaturated fatty acids ratio.

Aside from its other harmful consequences, smoking modulates the fatty acid profile of human milk.

The purpose of this study was to determine whether physical fitness is linked to academic success in middle school students.

The FITNESSGRAM test battery assessed students (n = 838) in the five components of health-related fitness. The Illinois Standardized Achievement Test (ISAT) was used to assess academic achievement in reading and math.

The largest correlations were seen for aerobic fitness and muscular endurance (ranging from 0.12 to 0.27, all p < 0.05). Boys in the Healthy Fitness Zone (HFZ) for aerobic fitness or muscular endurance were 2.5–3 times more likely to pass their math or reading exams. Girls in the HFZ for aerobic fitness were approximately 2–4 times as likely to meet or exceed reading and math test standards.

Aerobic capacity and muscular endurance seem to positively affect academic achievement in middle school students.

Normal growth is a sign of good health. Monitoring for growth disturbances is fundamental to children's health care. Early detection and diagnosis of the causes of short stature allows management of underlying medical conditions, optimizing attainment of good health and normal adult height.

This review summarizes currently available information on monitoring for short stature in children and conditions usually associated with short stature and summarizes the authors’ conclusions on the early recognition of growth disorders.

To determine the incidence rate and characteristics in patients with testicular torsion in Taiwan using a nationwide insurance database.

This study utilizes a subset of national health insurance research database, which contains the data of all paid medical benefit claims over the period 1997–2010 for in 1 000 000 beneficiaries in 2005. We analysed claims data for all male subjects younger than 25 years with the diagnosis of testicular torsion.

A total of 86 subjects younger than 25 years with the diagnosis of testicular torsion were included. Among them, 22 (25.6%) underwent orchiectomies and 64 (74.4%) underwent orchiopexies. The estimated incidence of testicular torsion was 3.5 per 100 000 person-years. There are two peaks in the age-specific incidence rates: the first in boys aged 10–14 years (at 7.7 per 100 000 person-years) and the second in male infants aged <1 year (at 7.6 per 100 000 person-years). There was significant difference between orchiectomy and orchiopexy groups in the Insurance fee (p = 0.032).

The incidence of testicular torsion in Taiwan was similar with previous report in the United States. It is important to improve the medical access to achieve better outcomes of testicular torsion.

To summarize the diversity of assessment and management for chronic orofacial pain associated with a disease (COFPAD) in children. We performed a review of the literature up to May 2012. Hetero-evaluation and self-assessment are used according to age of children. Strict management of the cause is not sufficient for children with COFPAD without a multidisciplinary approach combining pharmacotherapy, psychology and physiotherapy.

The multidisciplinary approach is the key of management for children with COFPAD.

Haemodynamically significant patent ductus arteriosus (hsPDA) is frequently observed in premature infants. This study was conducted to explore whether the blood BNP can be a valuable biomarker to assess the necessity of treatment for hsPDA in premature infants.

Serial measurements of the blood BNP were performed during the first 5 days of life in premature infants with hsPDA (Group I) and those without hsPDA (Group N). The definition of the hsPDA was the PDA requiring treatment, such as indomethacin administration and/or surgical ligation.

Forty-six subjects were enrolled. Compared with Group N, Group I showed significantly higher level of blood BNP at postnatal 24–96 h and demonstrated the peak value at postnatal 24–48 h. With the ROC curve using the data at postnatal 24–48 h in Group I, we deduced the predictive value of 250 pg/mL of blood BNP for indomethacin treatment. Similarly, with the ROC curve using the maximal value of blood BNP within the first 5 days of life, the predictive value of 2000 pg/mL for surgical ligation was deduced.

Blood BNP during early postnatal period can be a useful biomarker to assess the necessity of treatment for hsPDA in premature infants.

To describe parents' experiences of factors that influenced their stay with their extremely preterm infants in a neonatal intensive care unit (NICU).

This study has a qualitative descriptive design based on semistructured interviews conducted with seven mothers and six fathers.

Opportunities to stay overnight together with their infant facilitated parental presence, and opportunities for taking over their infant's care empowered the parents in their parental role and increased their motivation to stay. Kangaroo mother care helped them to feel in control and feel needed, which increased their presence. High levels of illumination and noise rendered it difficult for parents to sleep and stay overnight with the infant. Low staffing levels limited their use of kangaroo mother care when they had to wait for assistance to transfer the infant from the incubator. Several participants perceived the performance of painful procedures on their child as stressful and as an obstacle to their presence.

Kangaroo mother care and active involvement in the infant's care gave parents a sense of control and strengthened their motivation to be with their infant. High levels of noise and illumination and a dismissive staff attitude were obstacles to parents' presence.

To assess patterns of change for different neuromotor functions in very low birth weight (VLBW) children during school age and to identify factors associated with improvement.

In a longitudinal study, we examined 65 prospectively enrolled VLBW children (38 female, 59%) without cerebral palsy at age six and 10 years. Measures included the evaluation of timed motor performance and motor overflow (MO) for the motor components of the Zurich Neuromotor Assessment (pure motor-, adaptive fine- and gross motor tasks, static balance) and a standardized neurological examination. Variables associated with improvement were assessed by multiple regression analyses.

Between six and 10 years, adaptive fine motor tasks (40% vs. 17% of children scoring below 10th percentile) and MO (77% vs. 55%) improved significantly (both p<0.01), while all other components remained stable (pure motor 23% vs. 25%, adaptive gross motor 26% vs. 34%, static balance 18% vs. 20%, respectively). Mild neurological abnormalities at 6 years of age were associated with less improvement.

Neuromotor functions improve in some children potentially reflecting catch up of maturational delay. However, the majority of neuromotor functions remain abnormal in a significant proportion of VLBW children.

The ‘two-step’ head-to-body delivery method, which involves waiting for the next contraction to deliver the shoulders, causes a decrease in umbilical artery pH. The aim of this study was to assess whether foetal acidemia activates gluconeogenesis.

We tested umbilical artery cord blood glucose concentration and pH after 341 spontaneous and 25 vacuum extractor ‘two-step’ vaginal deliveries (VD) and after 85 elective and 49 emergency caesarean sections (CS).

Cord blood glucose concentration was significantly higher (95.5 ± 21.4 mg/dL vs 75.6 ± 16.4, p < 0.001), and pH values significantly lower (7.31 ± 0.09 vs 7.33 ± 0.06, p = 0.003) in ‘two-step’ VD neonates than in CS delivered neonates. In addition, cord blood glucose concentration was significantly higher (101.4 ± 30.6 mg/dL, p = 0.004), and pH values were significantly lower (7.26 ± 0.10, p < 0.001) in VD by vacuum extractor than in all other groups. The cord blood glucose concentration is significantly and negatively correlated with pH in the study population (r = −0.094, p = 0.036) and strongly significantly and negatively correlated in VD by vacuum extractor (r = −0.594, p = 0.007).

Cord blood glucose concentrations are significantly higher and pH values significantly lower in ‘two-step’ VD neonates, indicating activated foetal gluconeogenesis.

The use of plain radiographs provides limited information on the placement of peripherally inserted central catheters (PICCs). Moreover, changes in upper extremity positioning cause migration of the catheters in neonates. This study aimed to investigate the use of echocardiography for determining catheter tip position, compared with plain radiographs, in low birthweight (LBW) infants in a tertiary neonatal intensive care unit.

The study examined the placement of 109 catheters in 89 infants born between September 2010 and December 2012. The placement of these catheters was controlled by echocardiography, with the patient's shoulder in adduction and the elbow in flexion. The number of catheter tips, echocardiographically identified within the heart, was expressed as a percentage of the total catheters deemed to be well positioned on plain radiographs.

The number of catheter tips that were echocardiographically identified within the heart was significant (25%, p < 0.001). Twenty-three catheters were repositioned to be outside of the heart, without any complications.

This study demonstrated the value of echocardiography for identifying the positioning of catheter tips in LBW infants. Echocardiography, coupled with initial plain radiographs, should be the gold standard for assessing PICC tip positions in those infants.

To determine the occurrence and risk factors of sudden unexpected postnatal collapse (SUPC) in presumably healthy newborn infants.

All live-born infants during a 30-month period, in five major delivery wards in Stockholm, were screened, and possible cases of SUPC thoroughly investigated. Infants were ≥35 weeks of gestation, had an Apgar score >8 at 10 min and collapsed within 24 h after birth. Maternal, infant, event characteristics and outcome data were collected.

Twenty-six cases of SUPC were found among 68 364 live-born infants, an incidence of 38/100 000 live births. Sixteen of these cases of SUPC required resuscitation with ventilation >1 min, and 14 of these remained unexplained (21/100 000). Fifteen of the 26 children were found in a prone position, during skin-to-skin contact, 18 were primipara, and 13 occurred during unsupervised breastfeeding at <2 h of age. Three cases occurred during smart cellular phone use by the mother. Five developed hypoxic–ischaemic encephalopathy (HIE) grade 2, and 4 underwent hypothermia treatment. Twenty-five infants had a favourable neurological outcome.

SUPC in apparent healthy babies is associated with initial, unsupervised breastfeeding, prone position, primiparity and distractions. Guidelines outlining the appropriate monitoring of newborns and safe early skin-to-skin contact should be implemented.

To determine the incidence and potential novel risk factors for catheter-associated bloodstream infections (CABSI) in neonates.

A retrospective study was conducted for infants admitted to the VU University Medical Center neonatal intensive care unit in 2007.

One hundred and ninety six infants with a total of 369 central catheters were included. The CABSI rate was 18.1 infections/1000 catheter-days (95% CI 13.7–23.8) according to adjusted criteria used by the Centers for Disease Control and Prevention prior to 2008. Umbilical catheters had a higher infection rate than nonumbilical central catheters: rate ratio (rate ratio 2.4, 95% CI 1.2–4.9). Longer umbilical catheter dwell-time also increased infection rate (p < 0.05). Gestational age, birth weight, duration of parenteral nutrition and the administration of all-in-one feeding mixture versus parenteral nutrition administered in separate components were not related to infection rate in multivariate analysis.

Of all catheter types, umbilical catheters carried the highest infection rate. Longer umbilical catheter dwell-time also increased infection rate. The present data suggest that the impact of gestational age and birth weight on infection rate is mainly due to a prolonged hospital stay. The composition, way of preparation and duration of parenteral nutrition did not seem to influence infection rate.

To compare the efficacy and tolerance of betamethasone (BTM) and hydrocortisone (HC) in weaning extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) from the ventilator.

Monocentric, retrospective, cohort analysis based on prospective, standardized collection of data between 2005 and 2011 in ELBW receiving postnatal steroids (PS) after the second week of life. We used BTM for the first 4 years, and thereafter HC. We compared extubation rates, growth, glycaemia and blood pressure.

Sixty-seven infants received PS: 35 BTM and 32 HC. Most infants (83% BTM vs. 72% HC) were extubated during treatment (p = 0.281). During PS, the need for insulin was similar. Mean arterial blood pressure was similar at day 3 of PS, but was significantly lower in infants treated by BTM 30 days after the end of treatment. The z-scores for body weight and head circumference indicated significantly greater loss in BTM than HC group. This persisted only for body weight after adjustment for differences in energy intake and corticosteroid dose.

Our study suggests that HC may be as efficient as BTM in facilitating the extubation of ELBW infants, without short-term adverse effects. Blood pressure monitoring and investigation of long-term neurodevelopment are nevertheless needed.

To evaluate the feasibility of initiation of exclusive enteral feeds on first day of life in very low birthweight infants >1200 g.

Haemodynamically stable infants with birthweights 1200–1500 g irrespective of gestational age were randomized into two groups. Study group: Enteral feeds 80 mL/kg/day started within 1 h of birth and increased by 20 mL/kg/day to 180 mL/kg/day. No intravenous fluids given. Control group: Intravenous fluids 50 mL/kg/day started along with enteral feeds 30 mL/kg/day within 1 h of birth and increased by 20 mL/kg/day to 180 mL/kg/day. The outcome measures were – primary: time to regain birthweight and secondary: duration of hospital stay, incidence of necrotizing enterocolitis and sepsis.

Twenty three babies randomized in each group. Infants in study group regained birthweight earlier [mean 5.52 days, SD ± 2.94] compared to those in control group [mean 12.7 days, SD ± 2.25] (p < 0.0001). Duration of hospital stay was lower in study group [mean 15.04 days, SD ± 5.26] compared to those in control group [mean 28.04 days, SD ± 6.76] (p < 0.0001). No necrotizing enterocolitis detected.

It is feasible to initiate exclusive enteral feeds from first day of life in stable infants with birthweight between 1200 and 1500 g without any parenteral fluid support. It leads to twice as faster regaining of birthweight and halves duration of hospital stay.

Recent research suggests that asthma may originate through defects in the airway epithelium, acquired in utero, and an altered response to infections after birth. Here, we examine whether asthma in adult life is associated with reduced body size at birth and poor living conditions in childhood.

We studied 658 people taking medication for asthma in a cohort of 13 345 men and women born in Helsinki, Finland, during 1934–1944. Their body and placental size at birth, and their living conditions and growth in childhood, had been recorded.

The odds ratios for asthma were 0.93 (95% CI 0.89–0.97, p = 0.001) per cm increase in birth length and 0.92 (0.89–0.96, p < 0.001) per cm increase in the length of placental surface. After allowing for size at birth, growth during childhood was unrelated to asthma. People who were born into families of low socio-economic status were at increased risk of later asthma.

Slow linear growth in utero, which could be a result of impaired placentation, increases the risk of later asthma. Slow linear growth may be associated with impaired development of the airways. Babies with impaired lung development born into families of low socio-economic status may be most vulnerable to the disease.

To evaluate the natural course, onset, diagnostics and long-term follow-up masturbation in infant girls, which up to now has only been described in case reports.

Nineteen consecutive healthy, masturbating girls, diagnosed in early infancy between three and 15 months, were followed up for an average of 8 years. All were diagnosed in the same Swedish hospital between May 1996 and June 2010. Ten girls were videotaped and/or directly observed while masturbating.

Mean age at onset of masturbation was 10.4 months. The diagnosis was based on history taking and clinical observation. Parents reported that masturbation ranged from a few times a week to two-to-fifty episodes a day. Twelve girls had stopped masturbating when this study was written, after a mean duration of 66 months. Their symptoms and diagnostics are described in detail.

This is the first follow-up study of girls who started masturbating in early infancy, with a mean duration of five-and-a-half years. Diagnosis may be difficult, but with awareness and knowledge of the condition, a normal physical and neurological examination, a detailed history from the parents and, in particular, video documentation, it can be settled without extensive investigations and the parents reassured.

Evaluation of the prevalence of coeliac disease (CD) in Greek paediatric population.

The project consists of two parts: (i) a pilot study of preschool children aged 2–6 years to test the feasibility and diagnostic accuracy of community-based screening and (ii) a CD prevalence study, by random clustered sampling and proportionate stratification of various geographical areas in Greece. Trained nonmedical staff performed a rapid immunochromatographic test to detect IgA antibodies to tTG-IgA and IgA deficiency. Toddlers with positive results were referred to a paediatric gastroenterologist for further assessment with serum anti-tTG IgA and EMA-IgA. Children with positive serum anti-tTG and anti-EMA underwent upper gastrointestinal tract endoscopy and small bowel biopsy and were subsequently in gluten-free diet.

In this project participated 1136 toddlers, who were tested at school. The prevalence of positive rapid anti-tTG screening was 1:154, of IgA deficiency 1:120 and of biopsy-proven CD 1:154. The prevalence of CD from this pilot study served as expected prevalence value for sample size calculation for the main prevalence study.

This protocol using rapid immunochromatographic test for the detection of both IgA deficiency and CD is easy to be performed by nonmedical staff in a community setting, enabling the accurate identification of new CD cases among asymptomatic population.

The numbers of refugee adolescents that arrive in Europe without their families has increased in recent years, particularly in Sweden. Research has demonstrated that these children have high rates of mental health problems, particularly depression and post-traumatic stress disorder, during the first years after resettlement. Despite this, there are also indications that many of these unaccompanied children are resourceful and arrive with a clear vision of a positive future in the new country. Follow-up studies in the United States and Norway have indicated fairly good social outcomes in the long term.

The education and care that unaccompanied minors receive during the first years after resettlement, together with their own drive to create a positive future, are key factors in their mental health and long-term adjustment.

To examine in-hospital infant feeding practices, focusing on initiation and prevalence of breastmilk expression and to describe the proportion of women having a breast pump immediately after birth.

Postpartum women were recruited from three hospitals in Melbourne, Australia, between 2009 and 2011. Inclusion criteria: having had a healthy singleton term infant, intending to breastfeed and fluency in English. Data were collected using a structured questionnaire.

Just over 1000 women were recruited at 24–48 h postpartum; 50% were primiparous. Forty-seven per cent of infants had been fully breastfeeding at the breast from birth, and another 47% had received at least some expressed breastmilk. Forty per cent of first-time mothers reported having had a problem breastfeeding, and 46% already had a breast pump prior to the birth of their infant.

Early breastfeeding problems were common, and less than half the infants had fed only at the breast in the first days of life. Given the normalization of breastmilk expression, more evidence is needed regarding the impact of expressing on duration of breastmilk feeding and maternal health outcomes.

To analyse growth of children with and without congenital heart block (CHB) born to anti-Ro/SSA positive mothers from birth to 18 years of age, using a population-based cohort of Swedish CHB patients.

Medical records for siblings with (n = 72) and without (n = 60) CHB born 1973–2009 to anti-Ro/SSA positive mothers were retrieved from child healthcare centres and school health services and used to extract data on growth from birth to 18 years.

Compared with reference standards, children with CHB were retarded in weight by 0.75–1.0 SD from birth to 2–3 years of age. Thereafter, the CHB children started to catch up, reaching the reference standards at 9–11 years of age. Pacemaker treatment was not correlated with the catch-up in growth. Individuals with CHB were retarded in both weight and height from birth to 9–11 years of age when compared to siblings without CHB, who did not demonstrate restriction in these measurements.

Presence of CHB is a more important predictor of growth restriction than maternal rheumatic disease and foetal anti-Ro/SSA exposure. The restriction persists for several years after birth, despite pacemaker treatment, which highlights the importance of follow-up of children with CHB regarding nutrition and growth.

To determine whether treatment for mild hip dysplasia instigated in the newborn period was preferred over a delayed treatment by the parents, as delayed treatment for mild hip dysplasia detected in newborns is an acceptable medical policy.

During a study period of 16 months from 2010 to 2011, parents attending the paediatric radiology outpatient clinic at Haukeland University Hospital for a follow-up of their baby with developmental dysplasia of the hip (DDH), were invited to fill in a questionnaire on parent satisfaction on information provided, and on follow-up and treatment given.

A total of 91 parents were included, of which 66 (72.5%) had their babies treated from birth (group 1), while 25 (27.5%) had their child treated from 5 weeks onwards (group 2).

Although parents in the delayed treatment group, in retrospect, were less satisfied with timing of the treatment than those in the early treatment group (p < 0.00), their general impression and total satisfaction did not differ (p = 0.29).

The overall parent satisfaction on follow-up and treatment did not differ according to whether treatment was instigated at birth or later in infancy.

This study aimed to investigate the association of children's obesity with parental attachment and psychological variables as impulsivity, self-control and efficiency of eating control.

This cross-sectional study was conducted among 202 obese students aged 9–13 years selected by multistage cluster sampling from different areas of Isfahan, Iran. Three questionnaires were considered to be answered by the students and one for their parents. The students completed the following questionnaires: (i) Inventory of Parent and Peer Attachment-Revised version for Children (IPPA-R); (ii) Impulsivity Scale (IS); (iii) Efficiency of Eating Control; and (iv) Self-control Rating Scale (SCRS).

The quality of children's attachment had direct effects on self-efficacy of eating management and on obesity by mediating of self-efficacy of eating. Moreover, attachment had direct effect on self-control and impulsivity, and in turn through these psychological variables, it had indirect effects on self-efficacy of eating management.

The findings of this study underscore the importance of parent–child attachment quality. It can be suggested that childhood obesity can be prevented and managed with creating a secure attachment bond between children and parents and increasing perceived self-efficacy eating management in children.

To explore Swedish child health nurses' views on their role of involving fathers at the Child Health Centres (CHCs).

Interviews with 17 experienced Swedish Child Health nurses nurses were recorded, transcribed and analysed using systematic text condensation. Following the first analysis, the transtheoretical model of behavioural change was used to interpret the results.

Four themes emerged during the analysis: (1) the nurses' own agenda; (2) nurses' opinion about the father's role; (3) nurses' gatekeeping; and (4) wanting more father involvement. Most nurses were in the precontemplation stage according to the transtheoretical model when they expressed their roles as nurses (Theme 1), how they perceived the father's role within the family (Theme 2) and how they actively encouraged mothers, but not fathers, to visit the CHCs (Theme 3/Mothers are our priority). Nurses in the contemplation stage started to consider involving fathers in the CHCs (Theme 3/The gate is closed…). Still others were in the preparation (Theme 4/Fathers are worthy of change) and action stages (Theme 4/Active in involving fathers), respectively.

Child Health nurses place more emphasis on engaging mothers than fathers in the services. To increase father involvement, nurses need support to become aware, initiate and maintain action.

To determine radiological and clinical chest radiographs (CRs) interpretation agreement in children with acute respiratory disease (ARD) versus clinical experience in multiple observers.

Chest radiographs obtained in 70 consecutive children at the emergency department in 2010–2011 for ARD were reviewed. They were interpreted by 1–10 paediatric residents, three board-certified paediatricians (BCPs), three paediatric pulmonologists and one paediatric radiologist. Chest radiographs were analysed for presence of 10 radiological features and five diagnoses. A short clinical and laboratory context was given. Each child was given a clinical decision. Statistical analysis was by Fleiss’ kappa for multiple observers.

Kappas by selected major diagnostic features and by observer experience were expressed relative to diagnosis by paediatric radiologist. Best agreements were for pleural effusion and pneumonia and worst for normal X-ray, hyperinflation and atelectasis. Years of experience were influential. Antibiotics for pneumonia diagnosed by radiologist would not have been prescribed in 23% of cases by residents, 25% by BCPs and 15% by pulmonologists.

In ARD in children, there is little interobserver agreement, especially among residents, which may impact on major clinical decision. There is a need to systematically train physicians in CRs reading.

To screen for neurological and behavioural disorders in a paediatric cohort of patients with coeliac disease (CD) in order to detect possible differences related to compliance with gluten-free diet (GFD).

We recruited a cohort of 139 patients divided into three groups: A (40 patients with newly diagnosed CD), B (54 patients with CD in remission after GFD) and C (45 patients with potential CD). Patients first underwent a screening neurological visit, detecting signs associated with CD, and then were evaluated with Pediatric Symptom Checklist (PSC), a psychosocial screen for cognitive, emotional and behavioural problems.

In the group B as compared to group A, there was a statistically significant decrease (p < 0.05) in the incidence of chronic fatigue, headache and inattention. The same applied to patients compliant to GFD vs. non-compliant. Potential coeliacs turning into overt CD had a higher incidence of headache and inattention compared with potential coeliacs showing normal mucosa. The PSC mean score in group A was statistically higher than in group B.

Gluten-free diet had a positive impact on neuropsychiatric symptoms. We suggest the use of PSC in the routine follow-up of coeliacs in order to allow an early detection of psychosocial problems.

To estimate whether and when children dying from a malignancy are recognized as being beyond cure and to study patterns of care the last weeks of life.

A nationwide retrospective medical record review was conducted. Medical records of 95 children (60% of eligible children) who died from a malignancy 2007–2009 in Sweden were studied.

Eighty-three children (87%) were treated without curative intent at the time of death. Children with haematological malignancies were less likely to be recognized as being beyond cure than children with brain tumours [relative risks (RR) 0.7; 95% confidence interval (CI) 0.6–0.9] or solid tumours (RR 0.8; 0.6–1.0). The transition to noncurative care varied from the last day of life to over four years prior to death (median 60 days). Children with haematological malignancies were treated with a curative intent closer to death and were also given chemotherapy (RR 5.5; 1.3–22.9), transfusions (RR 2.0; 1.0–4.0) and antibiotics (RR 5.3; 1.8–15.5) more frequently than children with brain tumours the last weeks of life.

The majority of children dying from a malignancy were treated with noncurative intent at the time of death. The timing of a transition in care varied with the diagnoses, being closer to death in children with haematological malignancies.

To analyse the association between tobacco smoking, exposure to second-hand smoke (SHS) and reports of wheezing and asthma in a sample of schoolchildren.

A structured questionnaire was administered to 1766 students (7th grade, aged 12–13 years) at 25 schools in Terrassa, Spain (2006). We determined the prevalence of active smoking, exposure to SHS and reports of wheezing and asthma, and their association by means of prevalence odds ratios (OR) and 95% confidence intervals (CI).

97.5% of children were nonsmokers, 1.5% were experimental smokers and 1% were regular smokers. 41.1% of children reported exposure to SHS at home, 40.0% at school, 53.9% in their leisure time and 33.2% while using private or public transportation. Wheezing was reported by 9.2% of children, and 9.2% reported asthma. A significant association was found between smoking tobacco and wheezing: OR in experimental smokers = 3.0 (95% CI 1.2–7.7), and OR in active smokers = 4.2 (95% CI 1.4–12.5). Exposure to SHS while using transportation was associated with wheezing (OR = 1.4; 95% CI 1.0–2.0). Tobacco smoking and exposure to SHS were not associated with asthma.

Active and experimental smokers, and those who reported exposure to SHS while using public or private transportation, had higher likelihood of reporting wheezing. No association between active or passive smoking and asthma was observed.

Both hypothermia and central nervous system (CNS) drugs may alter the predictive accuracy of amplitude-integrated electroencephalography (aEEG) in hypoxic–ischaemic encephalopathy (HIE). The aim was to assess the predictive value of aEEG in hypothermia-treated HIE infants. Furthermore, we intended to investigate the association of cumulative doses of CNS drugs with aEEG recovery.

Seventy term HIE infants treated with hypothermia for 72 h were continuously monitored by single-channel aEEG. Doses of administered morphine, phenobarbitone and midazolam were recorded. Poor outcome was defined as death or severe neurodevelopmental delay at 18-24 months (Bayley Scales of Infant Development II), good outcome as absence of these criteria.

Poor outcome n = 26, good outcome n = 44. Positive predictive values (PPV) of an abnormal background pattern to predict poor outcome were 0.5 at 6 h; 0.65 at 24 h; 0.82 at 48 h and 0.92 at 60 h. All infants who developed sleep–wake cycling (SWC) had a favourable outcome; the nondevelopment of SWC resulted in a PPV of 0.73 for a poor outcome. Cumulative doses of the investigated drugs did not differ between infants having an onset of a recovered background pattern before or after 24 h.

Amplitude-integrated electroencephalography provides reliable prediction of outcome from the 48th hour during hypothermia in HIE infants. Commonly used CNS drugs in HIE infants do not significantly delay aEEG recovery.

To describe gender difference in a total population of children with cerebral palsy (CP), related to subtype, gross and fine motor function, and to compare CP incidence trends in girls and boys.

All 590 children with CP born in southern Sweden 1990–2005 were included. CP subtype was classified according to the Surveillance of Cerebral Palsy in Europe, gross motor function according to Gross Motor Function Classification System (GMFCS) and manual ability according to Manual Ability Classification System (MACS). Trends in CP incidence by birth year were analysed using Poisson regression modelling.

There was a male predominance in all levels of GMFCS except level II, in all levels of MACS and in all CP subtypes except ataxic CP. There was no statistically significant difference between males and females regarding gross motor function or manual ability. The CP incidence trends in boys compared with girls did not change during the period 1990–2005.

No equalization was detected in the incidence of CP between girls and boys during recent years in this total population. We could not confirm any consistent sex difference in motor function levels. Male sex is a risk factor for CP.

To evaluate the incidence, clinical features and outcome of acute poisoning in children of less than 6 years of age in northern Finland.

Children hospitalized with acute poisoning at the Oulu University Hospital between 1991 and 2010 were retrospectively evaluated from hospital records.

There were 334 hospital admissions due to acute poisoning during the study period, with an overall incidence rate of 5.2 per 10 000 per year, decreasing slightly from 6.7 in 1991–1995 to 4.5 in 2006–2010. Mean length of a hospital stay was 1.2 (SD ± 1.26) days. The most common substances ingested were terbutaline (12.3%), benzodiazepines (12.0%) and dishwasher powder (9.3%). Almost half of the patients were admitted to the paediatric intensive care unit, but most only required supportive care. Specific antidotes were administered in 16 cases. Three patients suffered from aspiration pneumonia as a result of ingesting poison, but no children died during the study.

Poisoning is a fairly common cause of hospital admission in children under the age of six. In most cases, their clinical condition is good, and they can be discharged after a short surveillance period.

To determine associations between ADRB2 polymorphisms and lung function through childhood, and possible modification by gender, pet keeping or tobacco smoke.

Four ADRB2 single nucleotide polymorphisms (rs1042711, rs1042713, rs1042714 and rs1800888) were genotyped in 953 children from the prospective birth cohort ‘Environment and Childhood Asthma’ study and analysed for association with flow-volume parameters at birth (tidal breathing) and at 10 years of age (maximally forced), stratified by environmental exposures.

The risk of reduced lung function was reduced in 10-year-old children carrying the most common ADRB2 haplotype (CGGC) (OR 0.45 (95% CI 0.25, 0.82)), whereas there was no association between lung function at birth and ADRB2 haplotypes. Tobacco smoke exposure, gender and pet keeping did not significantly interact with the haplotypes in influencing lung function.

This study demonstrates a possible protective effect by the ADRB2 haplotype I (CGGC) on reduced FEV₁ in 10-year-old children, whereas no ADRB2 geno-/haplotypes were significantly associated with neonatal lung function. The ADRB2 gene thus appears to contribute to lung function development in childhood, independently of smoking, pets and gender.

While childhood obesity is a global problem, the extent and severity of the problem in United States, has resulted in a number of new initiatives, including recent hospital initiatives to limit the sale of sweetened beverages and other high calorie drinks in hospital vending machines and cafeterias. These proposed policy changes are not unique to United States, but are more comprehensive in the number of proposed hospitals that they will impact. Meanwhile, however, it is advised, that these initiatives should focus on banning sugar sweetened beverages, including sodas, 100% fruit juice and sports drinks, from hospital cafeterias and vending machines instead of limiting their presence, so as to ensure the success of these programs in reducing the prevalence of childhood obesity. If US hospitals comprehensively remove sugar sweetened beverages from their cafeterias and vending machines, these programs could subsequently become a model for efforts to address childhood obesity in other areas of the world.

Hospitals should be a model for health care reform in their communities and removing sugar sweetened beverages is a necessary first step.

Toll-like receptors are vital transmembrane receptors that initiate the innate immune response to many micro-organisms. The discovery of these receptors has improved our understanding of host–pathogen interactions, and these receptors play an important role in the pathogenesis of multiple neonatal conditions such as sepsis and brain injury. Toll-like receptors, especially TLRs 2 and 4, are associated with necrotizing enterocolitis, periventricular leukomalacia and sepsis.

Toll-like receptor modulation may potentially be used as immunomodulators in the management of neonatal sepsis.

To determine whether adding recombinant erythropoietin to the intravenous (IV) solution and administering it as a 24-h continuous infusion would result in an erythropoietic effect not inferior to that seen with subcutaneous (SC) administration.

Infants weighing ≤1500 grams and ≤32 weeks of gestational age were randomly assigned at 72 h of life to receive erythropoietin (300 units/kg, 3 times a week until 36 complete weeks of postmenstrual age or discharge), either subcutaneously [erythropoietin subcutaneous (ESC) group] or added to IV fluids [erythropoietin intravenous (EIV) group].

One hundred infants were randomized (50 in the EIV group and 50 in the ESC group). The incidence of transfusions was comparable in the two groups, similar in baseline characteristics and haematologic values at study entry. Phlebotomy losses did not differ between groups, and at the end of the study, there were no differences in reticulocyte counts, transferrin saturation and ferritin. No differences in the incidence of side effects were observed.

In preterm infants, continuous intravenous administration of erythropoietin was not inferior to SC dosing.

Tissue factor (TF), a mediator between coagulation and inflammation, is upregulated in alveolar compartment and circulation in very low birthweight (VLBW) infants. We investigated the contribution of TF to systemic regulation of coagulation in VLBW infants.

We measured TF, total and free tissue factor pathway inhibitor (TFPIt, TFPIf), prothrombin fragment (F1 + 2), and thrombin–antithrombin complexes (TAT) in plasma from 51 VLBW infants during their first week of life.

F1 + 2 in cord plasma was high (1385 pmol/mL) and decreased postnatally to 17% (p = 0.002). TAT decreased from a high cord concentration to 3% postnatally (p < 0.001). Plasma TF increased and peaked on day 3, showing no correlation with F1 + 2 or TAT. TFPIt and TFPIf increased postnatally, correlating with TF (day 1 TFPIf: R = 0.595, p < 0.001, day 3 TFPIf: R = 0.582, p < 0.001). Based on the TF/TFPIf ratio, a relative excess of plasma TF over TFPIf probably prevailed on day 3.

In VLBW infants plasma TF fails to associate with thrombin formation. This is partly explained by release of TFPI. Despite TFPI, the newborn VLBW infant is subjected to a substantial circulating pool of TF with potential proinflammatory effects.

To measure the perceptions of parent support by parents, nurses and physicians.

Perceptions were compared among parents (n = 227), nurses (n = 178) and physicians (n = 43) in four neonatal intensive care units (NICU) using two versions of the Nurse Parent Support Tool (NPST and NPSTpro).

Overall, parents reported receiving support from nurses some or most of the time and their perceptions were correlated with aspects of their NICU experience. Nurses reported giving support to parents almost all of the time. The mean difference between parent and nurse ratings was smallest for instrumental support (0.26, 0.16–0.36; p < 0.001) and greatest for emotional support (0.82, 0.67–0.97; p < 0.001). Physicians overall reported that they gave support to parents most of the time, significantly less frequently than nurses (mean difference 0.58, 0.45–0.71; p < 0.001). They rated their support as most frequent on answering parents' questions satisfactorily and as least frequent on teaching parents how to give care to their baby.

NICU nurses and physicians should be encouraged to critically reflect on whether the type and consistency of support they provide to parents is in line with parents' perceptions and needs. Further research is needed on effective methods for health professionals to support parents of NICU infants.

To explore extremely low birth weight [ELBW] adolescents' self-reported quality of life [QoL] and compare it with control group of same age full-term peers.

This project is nested within a national follow-up study on the long-term outcome of ELBW infants born in Iceland in 1991–1995. Twenty-nine ELBW adolescents and 30 controls evaluated their QoL using KIDSCREEN-52. To evaluate group differences, Chi-square tests and Mann–Whitney U-tests were conducted. Multivariate logistic regression was used to determine the influence of birth weight on QoL in ten dimensions.

No differences were observed between the groups on six of ten KIDSCREEN dimensions. ELBW adolescents reported significantly lower QoL on four dimensions: Physical well-being (OR 3.41; CI, 1.14–10.25), Psychological well-being (OR 7.65; CI, 2.04–28.78), Moods and emotion (OR 5.20; CI, 1.53–17.82), and Self-perception (OR 3.20; CI, 1.05–9.74).

ELBW adolescents report similar social well-being and participation compared with same age full-term peers. Conversely, they report lower physical and emotional quality of life.

To study health, well-being in daily life, educational level and socio-economic status in adulthood in moderately premature infants and the relationship to gender and socio-economic status at birth.

Prospective long-term follow-up study of a cohort of infants with a gestational age between 32 and 37 weeks and term controls born between January 1972 and June 1973 in the municipality of Odense in Denmark. Information about life circumstances at 32 years was acquired by a mailed questionnaire.

The study comprised 373 participants aged 31–32 years (56% of the original cohort). Questionnaires were returned by 69 participants who were born moderately premature and 304 participants who were born at term (53 and 57%, respectively, of the original cohort). Multivariate analysis showed that social status and level of education at 32 years were predicted by social status and maternal educational level at birth with no demonstrable effects due to gestation or gender.

Moderately premature infants, born before the era of intensive care, at the age of 32 years with regard to health, quality of life, education and social status proved to fare as well as their term counterparts.

This study aims to characterize the impact of preterm birth, respiratory distress syndrome and bronchopulmonary dysplasia on quality of life and healthcare utilization in adulthood.

A mail survey on quality of life and respiratory health was sent to a list of potential subjects identified using the databases of the Régie de l'asssurance maladie du Québec. Four groups of adults born between 1987 and 1993 were compared: (i) preterm with bronchopulmonary dysplasia, (ii) preterm with respiratory distress syndrome, (iii) preterm without respiratory complications and (iv) term controls. As a complement, data from the governmental healthcare administrative databases were extracted for responders.

Although the groups differed in their use of healthcare services and prescription drugs, no clinically significant difference was observed for Saint George's Respiratory Questionnaire (SGRQ), SF-36v2 and Medical Research Council (MRC) Dyspnea Scale scores. However, compared to term subjects, bronchopulmonary dysplasia subjects were less likely to access higher education and more likely to be either invalid or unemployed.

Compared to term subjects, subjects with a history of prematurity and respiratory distress syndrome or bronchopulmonary dysplasia had similar health-related quality of life and respiratory symptoms despite greater use of healthcare services and prescription drugs.

To investigate the association between Trp64Arg polymorphism of the beta3-adrenergic receptor (ADRB3) gene and total fat mass, abdominal fat distribution, other metabolic derangements and metabolic syndrome (MS) in Japanese children.

Molecular screening of the ADRB3 gene polymorphism (Trp64Trp, Trp64Arg and Arg64Arg) was carried out in 132 children aged 6–12 years: 73 were obese (45 boys) and 59 were not obese (27 boys). Visceral fat (VF) and subcutaneous fat (SF) area were measured using magnetic resonance imaging, blood pressure, lipid and glucose profiles.

The frequencies of Arg carriers (Trp64Arg or Arg64Arg) were significantly higher in obese children with MS, compared to obese children without MS and nonobese children. In obese children, Arg carriers had significantly higher VF area, systolic and diastolic blood pressure, and low-density lipoprotein cholesterol and triglyceride than Arg noncarriers (Trp64Trp). However, there were no differences in total fat mass and SF area between the two groups. In nonobese children, none of these parameters differed significantly between Arg carriers and noncarriers.

Trp64Arg polymorphism of the ADRB3 gene may affect VF accumulation and be associated with MS, a cluster of conditions involving aggravated lipid metabolism and higher blood pressure, in Japanese children.

To study cord blood concentrations of adiponectin and leptin in children born by normal weight, overweight and obese mothers and to study these parameters in relation to a weight gain intervention programme for obese mothers.

Ten millilitre cord blood was collected and analysed for leptin and adiponectin concentrations in children with gestational age >37 weeks born by 60 normal weight, 45 overweight and 145 obese mothers. 82 obese mothers took part in a weight gain intervention programme.

Concentrations of leptin and adiponectin were higher in cord blood from children of overweight and obese mothers compared with children of normal weight mothers (leptin: Md 13.2, 30, 3 and 90.2 ng/mL respectively, p < 0.001; adiponectin 35.9, 205.4, 213.8 ng/L p < 0.001). No differences were found between overweight and obese mothers.

The weight gain intervention programme for obese pregnant women had significant effects on the weight gain during pregnancy but had no effects on cord blood serum concentrations of leptin and adiponectin.

Cord blood leptin and adiponectin concentrations were higher in children born by overweight or obese women compared with children of normal weight mothers. A weight gain intervention programme for obese pregnant women did not affect these results. Intrauterine exposition to high concentrations of leptin and adiponectin may play a role in weight development later in life.

We investigated a national cohort of children born extremely immature (<26 weeks gestation, EI) regarding the nature, frequency and severity of the behavioural problems related to the executive functions (EF) and concerning learning skills, from the perspectives of parents and teachers.

At 11 years of age 86 of 89 survivors of this cohort were studied and compared with an equal number of controls. Behaviours related to EF, and learning skills were assessed by a validated instrument, namely the Five to Fifteen questionnaire sent by mail to parents and teachers.

Compared with controls, parents of EI children reported significantly more problems in behaviours related to EF in all areas assessed (Attention, Hyperactivity/Impulsivity, Hypoactivity, Planning/Organizing, and Working Memory). Teachers′ ratings showed a similar pattern. EI children also displayed deficient skills in the 4 standard measures of learning skills. Multivariate analysis revealed that prematurity, gender and behavioural composite score was associated with learning skills. Only a relatively small proportion of EI children (10–30%) exhibited clinically significant impairments.

Despite a favourable outcome in many school-age children born at the threshold of viability, these are at increased risk of developing behavioural problems related to EF.

To chart early registered regulatory problems (RP) in a representative group of young children with and without autism spectrum disorder (ASD).

The target group comprised 208 preschool children with ASD, whose records from the Child Health Centres (CHC) were reviewed regarding numbers of consultations for excessive crying, feeding and sleeping problems. The records from an age- and gender-matched comparison group were obtained from the same CHCs as those of the index children

Significant differences between the ASD and comparison groups were found for each domain studied and when domains were collapsed. Two or more consultations had occurred in 44% of the children in the ASD group and in 16% of the comparison group (p < 0.001). No correlations were found with regard to gender, later severity of autism, cognitive level or degree of hyperactivity.

Regulatory problems (RP) were much more common in children who later received a diagnosis of ASD. Children with many RP in infancy require attention from CHC and paediatric services and need to be followed with regard to development and family support.

To explore the frequency and risk for injury among children with Attention-deficit/hyperactivity Disorder (ADHD) in Taiwan through a population-based study.

A total of 3616 subjects aged between four and twelve years diagnosed with ADHD were selected along with a comparison cohort comprising 18 080 subjects. Each subject was individually traced for a three-year period from their index date to identify those subjects who subsequently received a diagnosis of injury. We used stratified Cox proportional hazards regressions to examine the three-year injury-free survival rates between the two cohorts.

Of the subjects, the incidence rate of injury during the three-year follow-up period was 7.97 (95% CI = 7.45–8.51) and 5.36 (95% CI = 5.17–5.56) for the study and comparison cohort, respectively. After adjusting for geographic region, the hazard ratio (HR) of injury for subjects with ADHD was 1.64 (95% CI = 1.50–1.79) that of comparison subjects. In addition, we found children with ADHD aged between four and 6 years to demonstrate a greater HR (1.98, 95% CI = 1.72–2.28) than those aged between seven and twelve (HR = 1.46, 95% CI = 1.31–1.63).

Children with ADHD appear to be at a higher risk for injury than children that are not diagnosed with ADHD.

At the extremes of latitude, UVB intensity is insufficient for adequate vitamin D synthesis in winter. Fatty fish, vitamin D enriched milk, margarine and eggs are main dietary sources of vitamin D. Their elimination may increase the risk of vitamin D deficiency. The aim was to assess vitamin D status in food-allergic adolescents eliminating milk, egg and/or fish compared with adolescents on normal diets.

In winter, vitamin D intake was assessed by a food frequency questionnaire in 20 food-allergic adolescents and 42 controls in the population-based Obstructive Lung Disease In Northern Sweden (OLIN) cohort studies. Vitamin D supplementation was queried. Serum 25-hydroxyvitamin D [S-25(OH)D] and S-parathormone (S-PTH) levels were determined.

Mean (SD) dietary vitamin D intake was 7.9 (3.6) μg/day in allergic adolescents and 7.8 (3.4) in controls (p > 0.05). Mean (SD) S-25(OH)D levels in supplement consumers were 44 (18) nmol/L compared with 35 (10) in non-consumers (p = 0.03). S-25(OH)D and S-PTH levels were similar in food-allergic adolescents and controls (p > 0.05). Eighty-two percentage had deficient S-25(OH)D levels <50 nmol/L, and none reached levels >75 nmol/L.

Vitamin D deficiency was as common in food-allergic adolescents as in controls although the vitamin D intake met national recommendations. Large-scale studies on the prevalence of vitamin D deficiency in this region are needed.

The overall aim of the study was to assess the psychometric properties of the revised Diabetes Family Conflict Scale (DFCS), in a Swedish sample of children, mothers and fathers. A second aim was to analyse maternal and paternal effects separately.

One hundred and fifty-nine families from two diabetes centres participated in the study. The revised DFCS was administered to children aged 8–18 years and their parents. Internal consistency of the scale was measured with Cronbach's alpha, and its concurrent validity was evaluated using bivariate correlations. Independent t-tests were performed to test for differences between mother- and father reports.

The revised DFCS total scale exceeded the criteria for satisfactory internal consistency for the child-, mother- and father reports, as did the subscale direct management, with α-values ranging from 0.72 to 0.81. Furthermore, a higher level of reported conflict on the total scale was associated with poorer metabolic control, thus confirming concurrent validity of the instrument. This was true for mother-, father- and child reports.

In summary, the study concludes that the revised DFCS can be utilized as a valuable tool both in a research setting and in clinical practice.

The objective was to determine the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in faeces from healthy Swedish preschool children and to establish whether transmission took place between children in preschools.

Diapers from children attending preschools in Uppsala city were collected during September to October 2010, and the faeces was cultured. Antibiotic profiles and carriage of CTX-M, TEM, SHV and AmpC type enzymes were determined. PCR-positive isolates were further characterized by sequencing and epidemiological typing. Statistics on antibiotic use and ESBL producers in paediatric patients at Uppsala University Hospital were extracted for comparison.

A total of 313 stool specimens were obtained, representing 24.5% of all preschool children in Uppsala city. The carriage rate of ESBL-producing Enterobacteriaceae was 2.9% among these healthy children. The corresponding figure for patients in the same age group was 8.4%. Escherichia coli with CTX-M type enzymes predominated, and only one E. coli isolate carried genes-encoding CMY. CTX-M-producing E. coli isolates with identical genotypes were found in children with no familial relation at two different preschools.

Using diapers, the prevalence of ESBL-producing Enterobacteriaceae in children was quickly established, and, most likely, a transmission of ESBL-producing E. coli was for the first time documented between children at the same preschool.

To explore a less invasive way of assessing preload in neonates than fitting catheters to measure central venous pressure (CVP). This study evaluated the relationship between inferior vena cava (IVC) measurements and gestational age (GA) or body weight (BW) in term and premature infants and the correlation between those measurements and CVP in sick infants under mechanical ventilation.

We studied 57 clinically stable infants, together with14 sick infants fitted with central venous catheters to measure CVP. Subcostal transverse views were recorded at the level of the left branch of portal vein, and the minimum (D_S) and maximum (D_L) diameters of the IVC were measured. We evaluated the values of D_S and D_L and the S/L ratio (D_S divided by D_L) in the clinically stable infants and the correlation between S/L and CVP in the sick infants with central catheters.

D_S and D_L correlated positively and strongly with both GA and BW, whereas S/L was almost independent of both GA and BW and correlated strongly with CVP.

At the subcostal transverse views, S/L is much less affected by either GA or BW than D_S or D_L and correlates strongly with CVP in mechanically ventilated infants.

To identify the markers contributing to genetic susceptibility to asthma in Chinese Han children.

This study examined the potential association between childhood asthma and seven single nucleotide polymorphisms of Brain-derived Neurotrophic Factor (BDNF) – SNPs, rs16917204, rs6265, rs7103873, rs16917237, rs56164415, rs13306221 and rs10767664 – using the MassARRAY system. The participants, recruited between May 2009 and July 2012, were 319 children with asthma (mean age 9.82 ± 1.57 years) recruited from a hospital paediatric department and 309 healthy controls (mean age 10.25 ± 1.36 years), recruited from the medical examination centre at the same hospital.

We observed a significant association for rs6265 (χ² = 9.851, p = 0.002, OR = 1.427, 95% CI = 1.143–1.783), located in exon 4 of the BDNF. Another potential association was observed for rs13306221 (χ² = 4.316, p = 0.038, OR = 1.604, 95% CI = 1.024–2.512) in the promoter region of the BDNF. Strong linkage disequilibrium was observed in block 1 (D' > 0.9). Significantly more G-G-G haplotypes in block 1 were found in children with asthma.

These findings point to a role for BDNF polymorphisms in Chinese Han children with asthma and may inform future genetic or biological studies on childhood asthma.

The birth prevalence of sacrococcygeal teratoma (SCT) has been reported to range from 1:27 000 to 1:40 000. We assessed the population-based prevalence and clinical presentation of SCT over 22 years.

We identified all cases of SCT, including live births, stillbirths and terminations of pregnancy (TOPs), in the Finnish Register of Congenital Malformations, covering 1987–2008. Data on prenatal diagnoses, pregnancy outcomes, infant deaths and associated anomalies were collected.

One hundred and twenty four SCT cases were identified among 1 331 699 pregnancies. There were 89 (72%) live births, 13 (10%) stillbirths and 22 (18%) TOPs. The total prevalence of SCT was 1:10 700. Tumours were detected in utero in 55% of the pregnancies with SCT. The proportion of perinatal deaths among all SCT births was 28%. Thirty percentage of the cases had associated abnormalities (mainly of the urinary tract and various syndromes).

This nationwide, population-based study on SCT shows that the total and birth prevalence of SCT in Finland is markedly higher than previously reported. This may reflect true differences between populations, but may also be explained by accurate nationwide registration of SCTs. The high perinatal mortality rate has an impact on counselling of families and planning of deliveries.

The aim of this study was to investigate the direct relationship of sleep schedule and sleep quality variables between healthy preschool children and their parents, focusing on the influence of the difference in bedtime between each other.

Forty-seven Japanese 5-year-old children and their primary parent were studied. The parents completed questionnaires including the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. The children wore an actigraph for one week.

Although sleep patterns of children were generally independent of their parents, late sleep end time and bedtime of children were associated with parents' late sleep end time on weekends. For 87% of children and parents who shared a bedroom, sleep quality was negatively affected by a shorter difference in bedtimes between child and parent, but not by co-sleeping.

Sleep behaviours of parents can influence those of their children. For parents and children who share a bedroom, the timing of bedtime rather than co-sleeping may be a key factor in modulating sleep patterns. Trying to get children asleep and subsequently falling asleep at a similar time may disturb parents' sleep quality, which may subsequently affect that of their children.

Viral pneumonia is a serious complication in immunocompromised children. Its aetiology is difficult to identify owing to the limitations of conventional microbiological tests. The aim of this study was to determine whether polymerase chain reaction (PCR) assays for respiratory viruses increase the diagnostic yield of bronchoalveolar lavage (BAL) in immunocompromised children.

BAL samples obtained from immunocompromised children hospitalized with pneumonia were processed for respiratory viruses by viral culture, rapid antigen test and PCR (for CMV, adenovirus, influenza, parainfluenza, herpesvirus, RSV and hMPV).

The study group included 42 patients (mean age 7.2 ± 5.1 years) with 50 episodes of clinical pneumonia (50 BAL samples). Forty viral pathogens were identified in 30 episodes (60%). PCR increased the diagnostic rate by fourfold (75% identified by PCR alone, p < 0.0001). When viral culture and rapid antigen test were used as the gold standard, PCR was found to have high sensitivity (86–100% when assessed) and specificity (80–96%). The PCR results prompted the initiation of specific antiviral therapy and the avoidance of unnecessary antibiotic treatment in 17 (34%) episodes.

PCR-based diagnosis from BAL may increase the rate of pathogen detection in immunocompromised children, decrease the time to diagnosis and spare patients unnecessary antimicrobial treatment.

The objective of this study was to establish age-dependent urine NGAL (neutrophil gelatinase-associated lipocalin)/creatinine ratio values in healthy children and adolescents.

The study was performed using a random sample of 172 healthy children and adolescents (M–88, F–84), aged median 9.75 (0.2–17.9) years. Urine NGAL concentration was measured using a commercially available ELISA kit (R&D Systems, USA).

Median concentrations of urine NGAL/creatinine in particular age groups were analysed using anova. The differences between the youngest group of children under the age of 6 years and the rest of examined population were statistically significant. There were no differences in urine NGAL/creatinine between other age groups. Statistically significant negative correlation between urine NGAL/creatinine and age of subjects was found (r = −0.29, p < 0.05).

In the study, normative values of urine NGAL/creatinine for subjects aged 0.2–17.9 years have been established. These data may help clinicians and researchers to improve the interpretation of urine NGAL/creatinine ratio in children and adolescents. However, further studies using numerous data should be conducted to add reference values for urine NGAL partitioned by age and gender.

Aims of this study were to evaluate the efficacy of a cow's milk protein (CMP) elimination diet on induction and maintenance of remission and to define association with atopy in children with ulcerative colitis (UC).

Twenty-nine consecutive patients (mean age: 11.2 years; range: 4.6–17 years; F/M: 15/14) with newly diagnosed UC were randomized either to receive a CMP elimination diet (n = 14) or to continue a free diet (n = 15) associated with concomitant steroid induction and mesalazine maintenance treatment. Children were prospectively evaluated at four time points: within 1 month, 6 months and 1 year after diagnosis or at the time of relapse.

Twenty-five of the 29 enrolled patients responded to the UC induction therapy with a complete remission (86.2%), 13 belonging to CMP elimination diet group and 12 to free diet group (p = 0.59). Overall, our data showed that 7 of 13 (53.8%) patients treated with CMP elimination diet and 8 of 15 (53.3%) patients on free diet and UC therapy relapsed within 1 year of follow-up (p = 1).

In conclusion, data of this paediatric, randomized trial suggest that CMP elimination has no role in the management of UC in non-sensitized children.

We report three cases of severe infections in infants caused by Panton–Valentine leukocidin positive Staphylococcus aureus and evolved with a positive outcome. The literature of Panton–Valentine leukocidin positive Staphylococcus aureus infections in infants is reviewed.

Our findings suggest that a prompt identification of Panton–Valentine leukocidin positive Staphylococcus aureus and an appropriate therapy can reduce mortality and long-term sequelae. Further research is needed to specify features of Panton–Valentine leukocidin positive Staphylococcus aureus infections in infants.