BLOOD PRESSURE IN DANISH CHILDREN and ADOLESCENTS

Abstract. Ibsen, K. Kaas (University Paediatric Clinic, Children's Hospital, Fugle-bakken, Copenhagen, Denmark). Blood pressure in Danish children and adolescents. Acta Paediatr Scand, 70:27, 1981.–Blood pressure was measured in 946 Danish schoolchildren aged 7 to 18 years. The children had been randomly selected and serve as an urban reference population. Blood pressure was measured in 52 different schools, with the same Random-Zero-Sphygmomanometer, and all pressures were measured by the same person, under standardized conditions, to eliminate as many sources of error and uncertainties as possible. For both sexes an age-dependent significant increase in both systolic and diastolic blood pressure was observed. For both the systolic and the diastolic pressures, significant differences in blood presure measured before and after blood testing were observed.     

A SURVEY OF 164 FINNISH CHILDREN AND ADOLESCENTS WITH HYPERTENSION

Abstract. A retrospective analysis was performed on 164 children and adolescents with persistent hypertension. Among the un-selected 115 patients with hypertension seen within the last three years 47 (41%) exhibited renal disease, 37 (32%) coarctation of the aorta, 10 (9%) miscellaneous associated causes and 21 (18%) no associated cause (essential hypertension). A substantial number, 53/164, had a primary disease potentially curable by surgery, and in 37 patients the blood pressure was normalized postoperatively. The outcome depended mostly on the basic disease and the availability of chronic hemodialysis. 11/164 children have died, all because of terminal basic disease, and one with simultaneous hypertensive crisis. We thus recommend a thorough investigation in the case of a child with persistent hypertension.     

BLOOD PRESSURE IN SWEDISH SCHOOL CHILDREN

ABSTRACT, Systolic and diastolic blood pressure were measured in 1642 Swedish school children aged 12, 14, or 16 years. They represented 71% of all children in these age groups in the municipality where the investigation was done. The blood pressure was measured with an automatic, oscillometric blood pressure monitor. The systolic blood pressure increased significantly with age in both sexes. Boys aged 14 or 16 years had significantly higher systolic blood pressure than girls of the same ages.     

BLOOD PRESSURE IN CHILDREN WITH DIABETES MELLITUS

ABSTRACT. Blood pressure measurements were evaluated in 151 children aged 2–19 years old with insulin-dependent diabetes mellitus (DM) of a duration of few months to 15 ½ years. Compared with a reference group, the diabetic children had lower diastolic blood pressure (DBP) shortly after start of DM. There was no difference for the systolic blood pressure (SBP). After duration of diabetes of 5 years there were no significant differences in SBP and only significantly lower DBP in girls (median difference 5 mmHg, p <0.01), while the difference in boys is insignificant (median difference 2 mmHg, p =0.32). In a model describing the intraindividual variation in blood pressure and its dependence on age, weight and height it was found that age was insignificant when weight and height were included. For DBP height was also insignificant when weight was included. For the 9 children with retinal microaneurysms the average SBP was significantly higher than expected for diabetic children of that weight and height.     

ARTERIAL BLOOD PRESSURE SERUM LIPIDS AND CARDIOVASCULAR COMPLICATIONS IN FAMILIES OF HYPERTENSIVE CHILDREN

ABSTRACT. The arterial blood pressure (B. P.), the cardiovascular complications and the type of hyperlipoproteinemia were studied in 98 families of hypertensive children (group A) and in 100 families of normotensive children (group B). In group A, hypertension was found in 27% of the parents and 47.4% of grandparents, whereas in group B in 7.5% and 22.5% respectively. In siblings of hypertensive children hypertension was found in 13.5% as apposed to 5.4% of those of normotensive children. Cardiovascular complications were recorded in 27.5% in the parents and grandparents of group A and in 12% in group B. Hyperlipoproteinemia with obvious preponderance of type II (IIa, IIb) and IV was found in 58.5% of parents in group A and 21.1% in group B.     

GROWTH STATUS IN CHILDREN AND ADOLESCENTS WITH SICKLE CELL DISEASE

Objectives: To assess the BMI status of children and adolescents with sickle cell disease (SCD) and determine if zBMI status during adolescence is predicted by gender, childhood zBMI status, disease genotype, and healthcare utilization (emergency department visits or hospitalizations). Study Design: Medical chart reviews were conducted on 133 patients followed through a regional Comprehensive Sickle Cell Center to obtain anthropometric measures and healthcare utilization data. Gender-specific BMI z-scores were calculated based on Centers for Disease Control (CDC) norms using Epi Info NutStat Software and SPSS generated syntax. Data were summarized categorically across two time periods for each participant: childhood (age 6–12 years) and adolescence (age 13–18 years). Results: Males were three times more likely to be underweight in adolescence compared to CDC norms, whereas females were three times more likely to be obese in adolescence. In addition, regression analyses indicated that BMI in adolescence was predicted by gender, average weight in childhood, and the average number of emergency department visits. Conclusions: Children with SCD generally exhibit normal growth during childhood and adolescence, although 5–10% are at risk for poor growth or obesity. Prevention and intervention efforts should consider gender, average weight in childhood, and healthcare utilization factors.     

COLLOID OSMOTIC PRESSURE OF CORD BLOOD IN RELATION TO NEONATAL OUTCOME AND MODE OF DELIVERY

Kero, P., Korvenranta, H., Alamaakala, P., Selänne, P., Kiilholma, P., and Välimäki, I. (Department of Paediatrics, Department of Obstetrics and Gynaecology, and Cardiorespiratory Research Unit, University of Turku, Turku, Finland). Colloid osmotic pressure of cord blood in relation to neonatal outcome and mode of delivery. Acta Paediatr Scand, Suppl. 305: 88–91, 1983.—Colloid osmotic pressure (COP) of umbilical cord blood was measured in 184 infants, 113 of whom were delivered vaginally and 71 by Caesarean section, 152 were born at term and 32 were preterm (gestational age <37 weeks). Thirteen infants developed RDS, 20 had transient tachypnoea (TT) and 13 had perinatal asphyxia. There was a significant linear correlation between COP and total protein in cord blood ( r =0.91). Such a correlation was also found between COP of cord blood and gestational age in the non–RDS group ( r =0.49). COP was higher (19.6 mmHg) in the infants delivered vaginally than in those delivered by Caesarean section (16.8 mmHg, p <0.001). In the RDS group COP was 13.2 mmHg, in the TT group 15.6 mmHg and in the asphyctic group 16.9 mmHg (normal 18.3 mmHg). COP appeared to be of diagnostic assistance in babies developing neonatal pulmonary maladaptation syndromes.     

PERIPHERAL NEUROPATHY IN DIABETIC CHILDREN AND ADOLESCENTS

ABSTRACT. In order to establish the general prevalence of peripheral neuropathy in diabetic children and adolescents, median motor and sensory conduction velocities and the peroneal motor conduction velocity were registered in 161 unselected diabetic children and adolescents and 55 healthy controls. The influence of the duration and the balance of diabetes on the results was analysed in the diabetic group. In the controls the age correlated positively with the median motor and sensory conduction velocity, but not with peroneal motor conduction velocity. In diabetic children, the greatest impairment was found in the peroneal motor conduction velocity, 49 patients (30 %) had a value lower than -2SD below the mean normal value. There was a correlation between the balance of diabetes based on HbA₁ and glucosuria, and median and peroneal motor conduction velocities. The median motor conduction velocity was independent of the duration of diabetes, but a correlation was found between the duration of diabetes and peroneal motor conduction velocity impairment. Motor conduction velocity determination of the peroneal nerve can be used both in revealing and following the abnormality in peripheral nervous function in diabetic children. Regular follow-up of nervous function test results may help in assessing the importance of good metabolic control in preventing diabetic complications.     

5. MIGRAINE IN CHILDREN AND ADOLESCENTS

ABSTRACT
Although migraine has been considered in the past to be uncommon in children and adolescents, there is mounting evidence that it is not, and that it produces significant childhood morbidity. However, the clinical picture varies from case to case, and often from attack to attack in the same patient. Stress plays a most important role in triggering attacks of this familial disease, and the physician must be aware of this if his treatment is to be successful. In adolescent girls, falling estradiol plasma levels are apparently important in triggering attacks of migraine associated with menstruation. In an attack, the initial vasoconstrictive phase, mainly intracranial gives way to a vasodilative phase, mainly extracranial, which results from withdrawal of the vasoconstrictive support from the extracranial arteries which is normally provided by serotonin. The plasma level of the latter drops sharply during an attack, and its excretion product, 5-hydroxy-indole acetic acid, appeals in increased amounts in the urine.
Laboratory investigations, after a most careful, detailed history, and physical examination, should include an EEG, skull films and possibly a brain scan. Management includes prophylactic measures, both environmental and pharmacologic, and treatment of the attack itself, where promptness is the watchword.     

TREATMENT RESULTS OF OSTEOSARCOMA OF THE EXTREMITY IN CHILDREN AND ADOLESCENTS AT EGE UNIVERSITY HOSPITAL

Twenty-five patients were treated for osteosarcoma of the extremity at Ege University Hospital. Eight of them were metastatic. All patients received cisplatin, doxorubicin, ifosfamide, and methotrexate preoperatively. Twenty-three patients underwent surgery at around week 15 (11-18 weeks). All but one underwent limb-sparing surgery. While good responders continued to receive the same drugs, poor responders were given the same regimen before 1996, but high-dose ifosfamide alone after 1996. For all patients the projected event-free survival (EFS) rates were 63.5% at 2 years and 53% at 5 years. The projected overall survival (OS) rates were 72% at 2 years and 62% at 5 years. For nonmetastatic patients, 5-year EFS and OS rates were 67% as compared with metastatic patients (25 and 50%)( p = .01 for EFS; p > .05 for OS). The results show that nonmetastatic patients with osteosarcoma of the extremity have favorable prognosis on this therapy regimen, allowing a high rate of limb-sparing surgery.     

MEASUREMENT OF SYSTOLIC BLOOD PRESSURE IN FINGERS OF NEWBORN INFANTS

ABSTRACT: Gundersen, J. and Dahlin, K. (Departments of Surgery, Paediatrics and Clinical Physiology, General Hospital, S-21401 MalmU, Sweden). Measurement of systolic blood pressure in fingers of newborn infants. Acta Paediatr Scand, 64:741, 1975.–The systolic blood pressure in the index finger was measured using a minicuff and a strain gauge both placed around the finger. 122 measurements in four newborn infants were performed during monitoring in an incubator and the systolic blood pressure values obtained were compared with the simultaneously recorded intra-arterial blood pressure in the aorta. Good correlation between direct and indirect pressure values was found. An important advantage is that the measurements do not arouse the infants nor disturb their sleep. The procedure seems suited for further technical development and automatic measurements.     

HEMOGLOBIN, HEMATOCRIT AND RED BLOOD CELL COUNT IN "CAPILLARY" (SKIN-PRICK) BLOOD COMPARED TO VENOUS BLOOD IN CHILDREN

Hb, Htc and RBC in “capillary” (skin-prick) and venous blood have been compared in 30 children and in 30 adults (15 males and 15 females). “Capillary” blood was obtained from a 3 mm deep puncture in the finger with a “Medipoint” blood lancet. Higher mean values were found in venous blood, particularly in the children.     

TRACKING OF BLOOD PRESSURES IN DIABETIC CHILDREN

ABSTRACT. Repeated blood pressure measurements in 127 diabetic children, obtained at intervals of 6 months, were studied. Tracking of measurements described by the correlation between repeated observations of systolic blood pressure showed highest degree of tracking between consecutive measurements (0.38–0.76), while there was a lower degree of tracking between measurements at longer time intervals, and lower degree of tracking in the observations of diastolic blood pressure than of systolic blood pressure. After adjustment for changes in height and weight, the tracking correlations are slightly smaller on the whole. The tracking correlations are generally rather small and repeated measurements of blood pressure are necessary.     

COURSE OF RENAL FUNCTION IN IgA GLOMERULONEPHRITIS IN CHILDREN AND ADOLESCENTS

ABSTRACT. The pathophysiology of IgA GN was investigated in different stages of the disease. Seventeen patients who were between 3.5 and 16.5 years of age at the onset were included in the study. Clearance studies were performed repeatedly in 6 patients (in 5 of them over a period extending from the onset to 5-9.5 years) and only once in 9 patients (10-23 years after the onset). Two patients (one with uremia) were only evaluated clinically. C_In, C_PAH and U_NaV were studied during hydropenia (HP) and 3% isotonic saline volume expansion (VE). Shortly after the onset C_In, C_PAH and U_NaV were depressed. Renal function was essentially normal 1 and 2 years after the onset in spite of signs of active disease. A supernormal GFR was found in 7 patients after they had had the condition between 5 and 17 years. After a duration of IgA GN for >9 years 3 of 12 patients had developed hypertension and uremia and 2 had hypertension or labile BP. Three of 10 patients had a normal GFR and BP, but had increased natriuresis during VE. Only 2 of 10 patients were normotensive and had normal renal function. Disturbancies in the renal function are thus frequent in all stages of IgA GN and the changes seem to be related to the duration of the disease. Exaggerated natriuresis may indicate progressive disease.     

NUTRITIONAL ASSESSMENT OF PERIPHERAL BLOOD STEM CELL TRANSPLANTATION IN CHILDREN

Peripheral blood stem cell transplantation (PBSCT) has many advantages for patients because hematopoiesis and general condition return to normal more rapidly than they do following bone marrow transplantation. Thus, the authors hypothesize that the nutritional condition of patients also returns to normal more rapidly after PBSCT. The duration of insufficient nutrition was investigated in children undergoing PBSCT. The subjects of this study were 8 patients with malignant diseases. The factors measured were body weight, body fat, cholesterol, albumin, pre-albumin, and retinol-binding protein. These parameters were measured a day before transplantation, and then once a week for 4 weeks after transplantation. All parameters were recovered until day 28 from the lowest level in transplantation. In this study, all parameters returned to normal comparatively early. PBSCT causes little damage to patients' nutrition.     

CEREBELLAR-ATAXIC SYNDROME IN CHILDREN AND ADOLESCENTS WITH HYPOTHYROIDISM UNDER TREATMENT

ABSTRACT. Animal experiments and observations on quantitative growth of human cerebellum suggest a critical period when its development is particularly vulnerable to hypothyroidism. Sixty-seven patients aged 7–24 years with hypothyroidism under long-term treatment were examined for ataxic symptoms. These were found in 24 of 39 patients (60%) hypothyroid before or during the third month of life. Only 4 of 18 patients (20 %) hypothyroid later had cerebellar symptoms. Such symptoms could be evidence for the onset of hypothyroidism before or during the 3rd month of life. Seventeen (80%) of mentally retarded patients had cerebellar symptoms compared with 11 (30%) of 45 attending normal school. Even retrospecitvely, these data might permit a more accurate prognosis of further mental development in hypothyroid children.