What is the role of the prevention of allergy in the first period of life?

The widespread increase in the prevalence of allergic disease, which has occurred over the last 20 y, has created general concern in Europe and in the rest of the world. The reason for this increase is still partially unknown. In this period, despite a greater understanding of the pathogenesis and risk factors of allergies plus the greater efficacy of drugs to control the symptoms, the cost of intervention and the socio-economic impact are still very high. For these reasons, prevention in the first period of life represents a goal for both developed and developing countries in order to reduce this upward trend.     

Does the length of the history influence the outcome of pneumatic reduction of intussusception in children?

Purpose  

Intussusception is the most common cause of acute abdomen in infants and preschool children. Nonoperative reduction using air enema is an established treatment in children with intussusception. The aim of this study was to determine whether length of the history influences the outcome of pneumatic reduction of intussusception in children?     

Accurate localization of the position of the tip of a naso/orogastric tube in children; where is the location of the gastro-esophageal junction?

Background  

Abdominal radiographs are used to determine the location of the tip of a newly placed nasogastric tube. The precise location of the gastroesophageal junction has not been well described in the radiology literature.     

What is the place of genetics in the pathogenesis of pre-eclampsia?

It is most unlikely that there is a single 'pre-eclampsia (PE) gene'. We are probably looking for a cluster of polymorphisms which, possibly in conjunction with environmental factors, predispose to the development of the condition. Accurate phenotyping is vital for any genetic studies of PE, and since the disease is only clinically-detectable in the second half of pregnancy, is particularly difficult. It is increasingly likely that there is a fetal genetic contribution which can only be examined after birth. Candidate genes examined on the basis of displayed or hypothetical pathophysiological effects, but for which no evidence of association or linkage has been found have included HLA-DRbeta, HLA-G, and tumour necrosis factor alpha (chromosome 6), angiotensin-converting enzyme (chromosome 17) and CuZn superoxide dismutase (chromosome 21). Chromosomal exclusion mapping and a pedigree study suggest a role for genes on chromosomes 1, 3, 4, 9 or 18. Two genes concerned with clotting, those for factor 5 and methylenetetrahydrofolate reductase, lie on chromosome 1. Both have polymorphisms present in significantly higher frequency in women with PE, as well as showing functional abnormality. They probably predispose to the development of the condition, without being necessary for it. The angiotensinogen (Aogen) gene also lies on chromosome 1. The renin-angiotensin system may be activated during the early stages of PE and subsequently suppressed. In some populations, a relatively common polymorphism is present in raised frequency in women with PE, but it is also raised in non-pregnant hypertensive subjects. However, it is in partial linkage disequilibrium with another polymorphism which shows significantly distorted transmission from mother to fetus in PE pregnancies. Furthermore, its expression is significantly raised in the decidual spiral arteries; abnormal placentation is a feature of PE. We have also shown that a relatively common polymorphism in the angiotensin AT1 receptor gene (chromosome 3) is associated with raised density of the receptor. Thus far, studies of candidate genes have been on a small scale and have very much reflected the pathophysiological research interests of the investigators. The multifaceted nature of PE and the difficulties of accurate phenotyping require the accumulation of a large, very carefully phenotyped, database. It is hoped that funding will become available this year in the UK to allow the collection of such a database. The introduction of chip technology should allow genome scanning of the resource.     

Gender differences and typical nutrition concerns of the diets of preschool children – the results of the first stage of an intervention study

Background

Nutrition in children has an important influence on health both in childhood and adulthood. Actions aimed at improving children’s nutrition are essential, not only to the children and their families, but also to the whole society. The aim of the study was to present the results of nutrient intake before starting a nutrition and physical activity intervention programme, to investigate gender differences in nutrient intake and to discuss whether the preschoolers’ nutrient intake is similar to the intake of their peers from other countries.

Methods

Nutrient intake was estimated from seven-day weighed food records kept by parents and preschool staff individually for 122 4–6-year-old children who attended two preschools in Pi?a, north-western Poland. Nutrient intake was calculated using Dieta 4.0 computer programme including water intake and intake of nutrients from dietary supplements. Statistical analysis was performed using the IBM SPSS Statistics computer programme, version 21.0, according to gender. The study was approved by the Bioethics Committee of the Poznan University of Medical Sciences (reference number 886/08).

Results

Boys, in comparison to girls, were found to have statistically significantly higher intakes of total protein, total protein per kg of body weight, saturated fatty acids, total carbohydrates, available carbohydrates, lactose, sucrose, total water, vitamin A, beta-carotene, vitamin B₂, vitamin B₁₂, vitamin C, calcium, phosphorus, and magnesium. Statistically significantly higher percentage of girls than boys had intakes of vitamin E below AI.

Conclusions

Gender was a significant factor of nutrient intake in the studied preschool children. The main nutritional concerns in the studied preschoolers’ diets, irrespective of gender, are typical of the diets of preschool children from various parts of Europe and indicate the need to work out common nutritional strategies to improve preschoolers’ nutrition across Europe to reduce future burden of diet-related diseases to the European societies.

     

What is the purpose of launching the World Journal of Clinical Pediatrics?

The first issue of the World Journal of Clinical Pediatrics (WJCP), whose preparatory work was initiated on January 10, 2011, will be published on June 8, 2012. The WJCP editorial board has now been established and consists of 100 distinguished experts from 31 countries. Our purpose of launching the WJCP is to publish peer-reviewed, high-quality articles via an open-access online publishing model, thereby acting as a platform for communication between peers and the wider public, and maximizing the benefits to editorial board members, authors and readers.     

Toddlers’ relationships to peers in the processes of separation: from the discussion of observational accounts to the development of theory

In most books and papers about the separation process of infants and young children, the focus is on the relationship between parents and children. In this Viennese research about toddlers’ transitions from home care to day care, the impact of relational experiences became increasingly evident in the way young children experience, and work through, separation. Against that background observational material is used to describe interactions between observed children and caregivers as well as interactions between the children and their peers. The paper also discusses ways in which peer relationships were helpful or not for toddlers struggling with primitive anxieties and other strong feelings. The paper goes on to consider young child observation used as a single-case research tool in order to develop a more general theory. It takes into account endeavours to develop a theory already undertaken by Esther Bick and in many subsequent publications where observational material is discussed. Methodological investigations of this issue, however, are rare. The authors argue that the acceptability of using the Tavistock Observation Model as a research tool is supported by discussing its methodology.     

In the footsteps of Frances Tustin: Further reflections on the construction of the body‐ego

The author cites material from infant observation and from work with children with autism which illustrates primitive processes of identification and their relation to the development of the body image. The sense of a skin which reliably contains the child's body is seen as being built up through the combination of eye contact with the mother, as a mediator of emotional containment, and tactile reinforcement of the child's sense of having a backbone. The author proposes the term ‘lateral object of primary identification’ to describe the baby's experience of his mother and himself each occupying half of his body. She describes the process by means of which the dual link with the mother — tactile and visual — is progressively inscribed in the major joints of the body, from the neck downwards, in the course of normal development. In this way, separation can be experienced as a loss of part of the body. The experience of losing part of the mouth, as described by Tustin, is discussed with reference to theories of containment (Bion) and projection (Green).     

Does the use of volumetric bladder ultrasound improve the success rate of suprapubic aspiration of urine?

OBJECTIVE: To determine whether a volumetric bladder scanner can improve the success rate of suprapubic aspiration and whether there is an optimal volume of urine required in the bladder before suprapubic aspiration should be attempted. DESIGN: Two-phase prospective study. SETTING: The emergency department of a tertiary children's hospital. SUBJECTS: Children younger than 2 years who required an uncontaminated urine specimen for microscopy and culture. METHODS: In phase one, all patients had an ultrasound followed by suprapubic aspiration. In phase two, patients were randomized to either ultrasound or no ultrasound. RESULTS: In phase one, 37 subjects had ultrasound measurement prior to attempting suprapubic aspiration; 28 of 31 (90%) had successful suprapubic aspiration when a minimum volume of 10 mL was detected on ultrasound and no 0-mL readings were encountered. In phase two, the overall success rate of obtaining urine with the aid of the bladder scanner was 31 of 39 subjects (79%), compared with 16 of 36 subjects (44%) without ultrasound. Ultrasound was also useful in deferring an attempt when less than 10 mL of urine was noted on the scan. CONCLUSIONS: The volumetric bladder scanner is a rapid, safe, and accurate device that, in this study, greatly improved the success rate of suprapubic aspiration in small children. It also helped to avoid time delays or multiple blind attempts at suprapubic aspiration by predicting volumes at which suprapubic aspiration should or should not be attempted.     

The Importance of Choice and Definition for the Measurement of Child Poverty—the case of Vietnam

Increased attention to childrens’ special position within poverty measurement resulted in the development of various child poverty approaches in the last decade. Analysis shows that their development processes involve a similar set of steps and decisions, predominantly taken in the same sequence. However, it also becomes apparent that many of these decisions are made implicitly rather than explicitly, resulting in unclear and non-transparent underlying constructs. Consequently, child poverty approaches often lack a solid and robust foundation and are misinterpreted and misunderstood when used for analytical and policy purposes. This paper distills a generic construction process from the analysis of existing child poverty approaches, presenting a tool for clear and transparent development of such approaches. It is then applied to the case of Vietnam, using household survey data, to illustrate its practical use and develop a Vietnam-specific child poverty approach. Findings suggest that 37% of all children are poor, whilst observing a large rural-urban divide but no significant differences between boys and girls.     

Should dopamine be the first line inotrope in the treatment of neonatal hypotension? Review of the evidence

AIM: To determine if dopamine is effective in treating neonatal hypotension and safe to use comparing to other inotropes. METHODS: This is a review of evidence on inotropic treatment of neonatal hypotension. Databases searched were MEDLINE and the Cochrane Library, a total of 134 studies were identified. Only studies with high quality evidence (level 1a and b and 2a) were included. After review, only eight studies were included in the final analysis. Pooled risk ratios derived for each outcome [Mantel-Haenzel (M-H) fixed effect] with CI, as reported in the Cochrane reviews were plotted in forest plot form. RESULTS: Eight articles met inclusion criteria, which all included treatment in preterm infants. Dopamine increased mean arterial blood pressure (BP) (n = 163; r = 0.88, 95%CI: 0.76 to 0.94) and systolic BP (n = 142; r = 0.81, 95%CI: 0.42 to 0.94) comparing to placebo. Dopamine has been shown overall to be statistically more effective in increasing BP than dobutamine (n = 251, r = 0.26, 95%CI: 0.20-0.32). However there were no differences in short term outcomes (periventricular leucomalacia, periventricular haemorrhage) and mortality between both drugs. There is no statistical evidence of dopamine being more effective than adrenaline or corticosteroids. There was no difference in morbidity and mortality outcomes when dopamine was compared to hydrocortisone (RR 1.81, 95%CI: 0.18 to 18.39) or adrenaline. CONCLUSION: In preterms, dopamine is the most studied drug, and we suggest it could be used as first line treatment in hypotension.     

Is adrenomedullin involved in the pathophysiology of persistent pulmonary hypertension of the newborn?

Although adrenomedullin (ADM) is a potent vasodilating peptide reported to play a possible role in the mechanisms of fetal lung differentiation and maturation, the ADM blood level in fetuses and in neonates with persistent pulmonary hypertension (PPHN) and pulmonary hypoplasia is not known. Therefore, we examined 15 patients with PPHN: 10 with congenital diaphragmatic hernia, four with congenital cystic adenomatoid malformation of the lung, and one with misalignment of pulmonary vessels with alveolar capillary dysplasia. Eight surgical patients with neonatal conditions such as intestinal atresia served as controls. Blood samples were drawn from the umbilical artery and vein at birth, and arterial blood was drawn from patients with PPHN on the 3rd and 6th days after birth. Plasma levels of ADM were measured by radiometric assay. Plasma levels of ADM in the umbilical artery and vein were elevated in patients with PPHN compared with controls, and in all groups the levels in the umbilical vein were higher than those in the umbilical artery. The arterial levels in patients with poor prognoses were elevated on the 3rd and 6th days after birth compared with those in survivors. These results indicate that ADM may be involved in the pathophysiology of PPHN and in the mechanisms of lung differentiation and/or maturation.     

Evaluation of the Malnourished Children's Recuperation Program in the town of Embu, located in the Metropolitan Area of São Paulo

The objective of this study is to assess the anthropometric evolution of children who had been assisted by the Malnourished Children's Recuperation Program in the town of Embu, as well as to analyze some variables that interfered in this evaluation. The study included 233 children aged under five, enrolled in the program from January 1984 to December 1985. 201 (86,3%) were undernourished grade II and 32 (13,7%) grade III, according to Gomez. The percentage increase of Weight in relation to Age (W/A) and Height in relation to Age (H/A) - outcome variables, in the first and last examinations in the program - were analyzed, using the multiple linear regression. Younger children and in worse nutritional conditions showed higher W/A and H/A increases. Low birth weight, more frequent examinations, and longer stay in the program were associated to lower W/A increases. The presence of chronical pathologies jeopardized the H/A rate increases. This result strengthens the importance of developing programs for the assistance of undernourished children, due to higher risk of morbi-mortality in this group, mainly in younger children and with worse nutritional conditions.