Alpha fetoprotein levels in neonatal hyperbilirubinaemia

Serum alpha fetoprotein (AFP) levels were studied in 15 neonatally hyperbilirubinaemic children and 15 controls matched for sex and gestational age. All children were born between 38 and 40 weeks of gestation. During the first seven weeks of postnatal life hyperbilirubinaemic children had serum AFP concentrations over twice as high as controls. At the age of 5-7 days the mean (+/- S.E.M.) serum AFP values were 52.4 +/- 5.8 mg/l for hyperbilirubinaemic children and 24.8 +/- 4.3 mg/l for controls (p less than 0.001). At 20-25 days of age they were 7.28 +/- 1.10 and 2.75 +/- 0.45 mg/l, respectively (p less than 0.001), and at 40-49 days 1.39 +/- 0.21 and 0.46 +/- 0.07 mg/l (p less than 0.001). However, no correlation was found between serum bilirubin and AFP concentrations in hyperbilirubinaemic children.     

ENDOGENOUS CLEARANCE RATE AND SYNTHESIS OF ALPHAFOETOPROTEIN DURING AND AFTER BLOOD EXCHANGE TRANSFUSION IN HYPERBILIRUBINAEMIC NEWBORNS

Abstract. Teppo, A.-M. and Simell, O. (Department of Paediatrics, University of Helsinki, Helsinki, Finland). Endogenous clearance rate and synthesis of alphafoetoprotein during and after blood exchange transfusion in hyperbilirubinaemic newborns. Acta Paediatr Scand, 69: 491, 1980. —Plasma alphafoetoprotein (AFP) concentration was monitored in 22 hyperbilirubinaemic infants during blood exchange transfusion at the age of 0–4 days, in order to determine the endogenous clearance rate and demonstrate possible postnatal synthesis of AFP. The rapid fall in plasma AFP during the transfusion to 19±4% (mean ±1 S.D.) was followed by an increase to 81±15% of the initial concentration; only a 68% rise was expected after the establishment of a new equilibrium between the intra- and extravascular pools of AFP. Repeated transfusions in the same individuals gave similar findings. In two infants the total amount of AFP in these pools increased by 4.0–7.4 mg after the transfusions. The results could be accounted for by postnatal AFP synthesis. Because of the diffusion of AFP from the extravascular compartment to the intravascular pool the actual turnover rate of AFP could not be measured. The estimated magnitude of endogenous turnover rate of AFP, 0.02–0.09 min^-1, gave a mean half-life of about 20 min, which is distinctly shorter than that of AFP in plasma (3–5 days); this could be due to either continuous synthesis of AFP or transfer of presynthesized AFP from the liver cells to extracellular pool. We postulate that either the synthesis or the turnover rate of AFP is controlled by the plasma AFP concentration via a negative feedback mechanism.     

LDH-ISOENZYMES IN CHILDREN

ABSTRACT: Christoffersen, J., Marner, T. and Raabo, E. (Department of Paediatrics, Glostrup Hospital, Glostrup, Denmark). LDH-isoenzymes in children. A comparison of values from capillary and venous blood. Acta Paediatr Scand, 64: 822, 1975.–A comparison has been made of serum values of LDH-isoenzymes obtained by simultaneous sampling of capillary and venous blood in 40 normal children. No satisfactory correlation between the paired values could be found. Evaluation of the pattern of serum LDH-isoenzymes in children therefore requires a reference, i.e. normal values of isoenzymes obtained by the same technique of blood sampling.     

MEDIASTINAL LYMPHOSARCOMA SIMULATING PERICARDITIS

ABSTRACT: Berg, M., Wilander, E. and Eriksson, A. (Departments of Paediatrics and Pathology, University Hospital, Uppsala, and Department of Paediatrics, Central Hospital, Boden, Sweden). Mediastinal lymphosarcoma simulating pericarditis. Acta Paediatr Scand, 64: 873, 1975–A case of lymphosarcoma of the heart in a 10-year-old boy is presented. The clinical picture simulated a pericarditis. Prednisolone had a remarkably good temporary effect. Post-mortem examination showed a highly differentiated lymphosarcoma invading the pericardium and myocardium from a primary mediastinal localisation. Cytologic examination for malignant cells in the pericardial fluid must not be forgotten in a case of unexplained pericardial effusion.     

PUBERTAL GROWTH AS REFLECTED BY SIMULTANEOUS CHANGES IN BONE MINERAL CONTENT AND SERUM ALKALINE PHOSPHATASE

Abstract. Krabbe, S., Christiansen, C., Rødbro, P and Transbøl, I. (University Clinic of Paediatrics, Children's Hospital Fuglebakken, Copenhagen F, Department of Clinical Chemistry, Glostrup Hospital, Glostrup, Department of Clinical Physiology Aalborg Sygehus Syd, Aalborg, and Division of Endocrinology, Department of Internal Medicine, Hvidovre Hospital, University Hospital of Copenhagen, Hvidovre, Denmark). Pubertal growth as reflected by stimultaneous changes in bone mineral content and serum alkaline phosphatase. Acta Paediatr Scand, 69:49, 1980.—Bone mineral content and total serum alkaline phosphatase were measured simultaneously in 230 normal children and adolescents aged 7–20 years. The bone mineral content showed almost no variation from the age of 7 to 13 in boys and 7 to 11 in girls. Thereafter a sharp increase was seen in both sexes with a highly significant sex difference between the mean values. Bone mineral content showed a fairly high correlation with age, height, weight, and surface area in boys. Before the time of the growth spurt, however, these variables were poorly correlated or not correlated at all. Concentrations of total serum alkaline phosphatase increased up to the age of 14 in boys and 11 in girls. Thereafter a rapid fall was seen in both sexes, the mean levels being significantly higher in boys. The fall approximated adult levels in boys by the age of 20 and in girls by 18. A significant negative correlation between bone mineral content and serum alkaline phosphatase was seen both in boys ( r = 0.71, p < 0.001) and in girls ( r = 0.79, p < 0.001)     

THE EFFECT OF DIETARY γ-TOCOPHEROL ON SERUM TOCOPHEROLS IN FORMULA-FED INFANTS

ABSTRACT. Jansson, L., Holmberg, L. and Jakobsson, I. (Department of Paediatrics, University of Lund, Malmö General Hospital, Malmö, Sweden). The effect of dietary γ-tocopherol on serum tocopherols in formula-fed infants. Acta Paediatr Scand, 70:297, 1981.–The levels of α-, β- and γ-tocopherol were determined in two formulas (Nutramigen± and Soja-semp±) and in 20 infants fed either of these formulas. The y-tocopherol concentration in Nutramigen was 22.8±1.9 µmol/l; and that in Soja-semp 3.7±0.5 µmol/l. This difference was reflected in the serum tocopherols of the infants, since in the 10 infants fed Nutramigen, γ-tocopherol accounted for 16.7 ± 7.9% of the total tocopherols compared to 4.2±1.8% in the 10 infants fed Soja-semp. The study shows that γ-tocopherol accumulates in the serum of infants fed large amounts of it. The serum γ-tocopherol level should therefore be taken into account, when estimating the vitamin E status in humans, especially when the intake of γ-tocopherol is high.     

ELEVATED ERYTHROCYTE ADENOSINE DEAMINASE ACTIVITY IN DOWN'S SYNDROME

Abstract. Puukka, R., Puukka, M., Linna, S-L., Joensuu, T. and Kouvalainen, K. (Departments of Clinical Chemistry and Paediatrics, University of Oulu, Oulu, Finland). Elevated erythrocyte adenosine deaminase activity in Down's syndrome. Acta Paediatr Scand, 70:739,.–Erythrocyte ADA activity was measured in 29 cases of Down's syndrome and in 29 age- and sex-matched control subjects. The mean activity (± S.D.) of ADA in Down's syndrome was 1 883±463 mU/g Hb (37°C) and 1 361 ±294 mll/g Hb in the controls. The difference was statistically significant ( p <0.001). The purine metabolism of Down's syndrome patients is discussed.     

THE EFFECT OF EXERCISE ON DIABETIC CONTROL AND HEMOGLOBIN A1 (HbA1) IN CHILDREN

Abstract. Dahl-Jørgensen, K., Meen, H. D., Hanssen, Kr. F. and Aagem, O. (Department of Paediatrics and Department of Internal Medicine, Aker Hospital and the Norwegian College of Physical Education and Sports, Oslo, Norway). Acta Paediatr Scand, Suppl. 283: 53, 1980.—14 children with juvenile diabetes mellitus (mean age 11 years, mean diabetes duration 5 years) were enrolled in a one-hour twice weekly supervised exercise program for 5 months. A group of 8 diabetic children of same age and diabetic duration served as control group. Maximum oxygen uptake was within normal range for all children. With this exercise program the maximum oxygen uptake of the training group did not change significantly compared with the control group. The physicians rating of degree of the metabolic control based on blood-glucose measurements and urinary glucose excretion did not change in any of the groups. The insulin dosage per kilo body weight remained unchanged in both groups. In the training group the HbA, values decreased during the exercise period from 15.1±2.2 (mean HbA₁%±1 S.D.) to 13.8±1.9 (2 p <0.001). In the control group the HbA₁ values did not change significantly (13.4± 1.9 to 12.9± 1.6; 2 p =0.20). In a co-study the effect of freezing and storage of hemolysates, resulting in increased levels of HbA₁, was demonstrated.     

Early Changes of Some Serum Proteins and Metals in Diabetic Children

ABSTRACT. Serum concentrations of prealbumin, albumin, orosomucoid, magnesium, zinc and calcium were studied in 30 children with newly diagnosed IDDM aged 3–15 years, during the first two years of the disease, and in 44 healthy control children. On admission serum prealbumin was significantly lower in IDDM children (149±48 mg/1) (M±SD) than in healthy controls (194±39 mg/1) ( p <.001). During the two years follow-up prealbumin increased significantly, but did not reach the level of healthy controls. Serum albumin was slightly increased at diagnosis ( p <0.01), but later decreased significantly ( p <0.01). Orosomucoid concentrations did not differ between diabetics and controls. Serum magnesium was initially within the reference interval but later decreased, and after 2 years of IDDM it was highly significantly reduced ( p <0.001). Serum zinc was significantly reduced in IDDM children at diagnosis ( p <0.001), but was within the reference interval after one and 2 years. Serum calcium was increased in the IDDM group at diagnosis ( p <0.01), but later normalized. It is concluded that in early IDDM there is a decrease in serum prealbumin and albumin, and serum magnesium decreases progressively, while serum zinc is only transiently reduced.     

EVALUATION OF A NEW SUSTAINED-RELEASE THEOPHYLLINE TABLET FOR CHILDREN

Abstract. Selvig, K., Alme, A., Rugs tad, H. E., Aas, K. and Bjerve, K. S. (Institute of Clinical Biochemistry, the Allergy Institute Voksentoppen, Department of Paediatrics and Department of Clinical Pharmacology, Rikshospitalet, Oslo 1, Norway). Evaluation of a new sustained-release theophylline tablet for children. Acta Paediatr Scand, 70: 929, 1981.-A new, low dose sustained-release tablet of theophylline has been developed in order to facilitate a correct dose regimen in asthmatic children treated with theophylline. The formulation (Euphyllin® retard mite w/groove) contains 128 mg of theophylline, and can easily be divided. The extent of bioavailability in adults is 0.91, and the peak serum concentration is reached after 8.7 h. 25 children treated with plain theophylline tablets were followed when changing to the sustained-release tablets. Compared to the plain tablets, the serum theophylline concentration before the morning dose was 29 μmol/l higher (range 12–51) when the same daily dose was given as a sustained-release preparation. The serum concentration fluctuations during one dosing interval were reduced with 13 μmol/l (0–26). Mild gastrointestinal side effects reported by the children when using the plain theophylline tablets all disappeared on changing to the sustained-release tablets.     

Adrenal Function in Asthmatic Children Treated with Inhaled Budesonide

Bisgaard, H., Pedersen S., Damkjær Nielsen M and Østerballe O. (Department of Paediatrics, University Hospital of Copenhagen, County of Gentofte, Copenhagen; Department of Paediatrics, County Hospital of Kolding; Department of Clinical Physiology, University Hospital of Copenhagen, County of Glostrup, Copenhagen; Department of Paediatrics, County Hospital of Viborg, Denmark). Adrenal function in asthmatic children treated with inhaled budesonide. Acta Paediatr Scand 80: 213, 1991
The effect of the inhaled topical steroid budesonide on adrenal function was evaluated in 33 children (aged 7–15 years) with moderate bronchial asthma. The trial was designed as a prospective single-blind study of the effect of budesonide in daily doses of 200 μg through 400 μg to 800 μg in three randomized consecutive periods of 8 weeks. The unstimulated diurnal production of cortisol was assessed by measurement of free cortisol in 24-hour urine samples at the end of each period. No significant dose-related suppression was found. The cortisol production did not differ significantly during treatment with 800 μg budesonide as compared to treatment with 200 μg budesonide (95% confidence interval: 74%–112%). It is concluded, that budesonide is a topical steroid with a favourable ratio between topical and systemic effects in asthmatic children.     

AUTOANTIBODIES TO TAMM-HORSFALL PROTEIN IN PATIENTS WITH CYSTIC FIBROSIS

Abstract. Fasth, A. and Kollberg, H. (Department of Paediatrics and Department of Immunology, Institute of Medical Microbiology, University of Göteborg, and Department of Paediatrics, University Hospital, Umea Sweden). Autoantibodies to Tamm-Horsfall protein in patients with cystic fibrosis. Acta Paediatr Scand, 69: 189, 1980.—Sera from 35 patients, 17 boys and 18 girls, with cystic fibrosis were analysed for autoantibodies to the Tamm-Horsfall protein. Significantly ( p > 0.001) elevated levels of specific IgG and IgA, but not IgM antibodies to Tamm-Horsfall protein were found. There was a considerable overlap between the values in the disease group and the control group. The highest values were found among the patients with liver involvement. The patients with marked lung abnormalities as well as those with positive bacterial culture of sputum had normal antibody levels.     

CHRONIC SUPRAVENTRICULAR TACHYCARDIA IN INFANCY AND CHILDHOOD

ABSTRACT: Jacobsen, J. R., Andersen, E. D., Sandøe, E., Videbeek, J. and Wennevold, A. (Medical Department B and Department of Paediatrics, Rigshospitalet, Queen Louise's Hospital for Children, Copenhagen, and Departments of Cardiology and Paediatrics, århus Kommunehospital, århus, Denmark). Chronic supraventricular tachycardia in infancy and childhood. Acta Paediatr Scand, 64:597, 1975.–The results of a one to 19 year follow-up study of 9 children with supraventricular tachycardia of more than one month's duration are reported. The ECG diagnosis of tachycardia was made before birth in one patient and between the ages of 8 months and 12 years in 8. Four had sustained and 4 had repetitive tachycardia, while one patient had both patterns at different times. Reciprocal rhythm was diagnosed in 3 patients and exit block in 2. Severe symptoms had occurred in 2 patients, but as a rule symptoms were mild or absent. No treatment abolished the arrhythmias but digitalis reduced the overall ventricular rate in 6 patients. After a duration of 1–7 years, 3 patients still had tachycardia at the follow-up. In the remaining 6 patients the tachycardia had subsided 7 months to 10 years after the onset.     

PERINATAL CAMPYLOBACTER FETUS SS JEJUNI ENTERITIS

ABSTRACT. Vesikari, T., Huttunen, L. and Mäki, R. (Department of Clinical Sciences, University of Tampere; Department of Paediatrics, Central Hospital of Päijät-Häme, and Department of Microbiology, Tampere Central Hospital, Finland). Perinatal Campylobacter fetus ss jejuni enteritis. Acta Paediatr Scand, 70:261, 1980. –A 2-day-old breast-fed male infant developed mucoid and bloody diarrhoea, and Campylobacter fetus ss jejuni was isolated from the stools but not from the blood. The probable source of transmission was his mother in whom symptoms of Campylobacter jejuni - associated illness began one day earlier. Both showed IgM, IgG and IgA antibody responses to autologous and reciprocal strains of Campylobacter jejuni as studied by ELISA.     

CLINICAL ASSESSMENT OF GESTATIONAL AGE IN THE NEWBORN INFANT

ABSTRACT. Vogt, H., Haneberg, B., Finne, P. H. and Stensberg, A. (Department of Paediatrics, University of Bergen, and Department of Clinical Chemistry, Akershus Central Hospital, University of Oslo, Norway). Clinical assessment of gestational age in the newborn infant. An evaluation of two methods. Acta Paediatr Scand, 70:669,.–The scoring systems of Dubowitz et al. and Parkin et al. were evaluated in two selected materials of newborn infants referred to a neonatal unit. Our estimation of gestational age by Dubowitz scores tended to be too high for the extreme prematures. "Small-for-dates" were also overestimated, whilst "appropriate-for-dates" and infants with respiratory difficulties were underestimated. "Large-for-dates" fell close to the standard curve. Ninety-five per cent confidence limits were up to ±5 weeks for Dubowitz scores and nearly ±6 weeks for Parkin scores. Further statistical analysis displayed some limitations in the use of linear regression formulas for scoring systems based on external and/or neurological characteristics. Thus, the results obtained with these methods must be used with caution in some selected newborn materials.     

THYROXINE-BINDING GLOBULIN DEFICIENCY IN EARLY CHILDHOOD

ABSTRACT. Jacobsen, B. B., Hansted, L. C, Brandt, N. J., Haahr, J., Hummer, L., Munkner, T. and Sorensen, S. S. (Department of Paediatrics, Viborg Hospital, Children's Hospital Fuglebakken, Department of Paediatrics, Section of Clinical Genetics and Department of Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark). Thyroxine-binding globulin deficiency in early childhood. Postnatal changes in serum concentrations of thyroid hormones and thyroid hormone-binding proteins. Acta Paediatr Scand, 70:155, 1981. –Serial determinations of serum thyroxine (T4), triiodothyronine (T3), thyrotropin(TSH), thyroid hormone-binding globulin (TBG), prealbumin (TBPA) and albumin were performed in a euthyroid girl with TBG deficiency and in her mother for a period of 22 months after delivery. At 8 days old the child had a serum TBG concentration around 50% of normal level which remained essentially unchanged during infancy. Total serum T4 and T3 concentrations were low, the free serum T4, free serum T3 and serum TSH concentrations were normal. The mother had received thyroid hormone from the age of 15 years. Her serum TBG level at 6 weeks post partum was similar to that of non-pregnant adults but decreased to about 50% of normal level, indicating a TBG deficiency. She remained euthyroid after withdrawal of T4 therapy. Serum TBPA and albumin concentrations were normal in mother and child. An X-linked inheritance of the TBG deficiency was suggested from a study of the family.     

THE INCIDENCE OF COELIAC DISEASE IN CHILDREN IN SOUTH-EAST SWEDEN

ABSTRACT. Stenhammar, L. and Johansson, C.-G. (Department of Paediatrics, Central Hospital, Norrköping and Department of Paediatrics, Central Hospital, Jönköping, Sweden). The incidence of coeliac disease in children in south-east Sweden. Acta Paediatr Scand, 70:379, 1981.–Among children born between 1969 and 1977 in two areas of south-east Sweden an initial flat small intestinal mucosa was found in 84 cases, 64 of whom were considered to have coeliac disease (CD) diagnosed mostly according to the criteria formulated by the European Society for Paediatric Gastroenterology and Nutrition. The incidence of CD was 1/859, which is in agreement with that of a recent report from south Sweden. This suggests that the incidence of CD is the same in the whole of Sweden. In the present study all patients with an initial flat mucosa improved clinically and histologically after 1 year or more on a gluten-free diet. When challenged with gluten, 19% did not relapse within 2 years, thus fulfilling the criteria for so-called transient gluten intolerance. These patients had a lower mean age of symptom debut and for first biopsy, compared with the patients with CD.     

DIAZEPAM RECTAL SOLUTION FOR HOME TREATMENT OF ACUTE SEIZURES IN CHILDREN

ABSTRACT. Hoppu, K. and Santavuori, P. (Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland). Diazepam rectal solution for home treatment of acute seizures in children. Acta Paediatr Scand, 70:369, 1981.–To gain clinical experience of treating acute convulsions in children with diazepam rectal solution, 17 epileptic children with prolonged convulsions were treated at home. The drug was used 65 times. On 2/3 of all occasions the seizure was interrupted in less than 15 min. A starting dose of 0.5 mg/kg is recommended, with a maximum of 20 mg per single dose. One patient had respiratory difficulties, one dizziness and two skin reactions.     

SCREENING FOR VIRAL INFECTIONS IN INFANTS WITH POOR INTRAUTERINE GROWTH

ABSTRACT. Andréasson, B., Svenningsen, N. W. and Nordenfelt, E. (Department of Paediatrics and Department of Medical Microbiology, University Hospital, Lund, Sweden). Screening for viral infections in infants with poor intrauterine growth. Acta Paediatr Scand 70:673,.–Viral excretion and immunoglobulin concentration during the first 3 days of life were studied in a consecutive study of 104 infants with poor intrauterine growth. Other possible etiologies of poor intrauterine growth were analysed retrospectively. The etiology of poor intrauterine growth could not be found in 34 % of the babies. The data obtained showed no etiological relationship between poor intrauterine growth in our population and viral infection.     

THE EFFECT OF A VIRTUALLY CHOLESTEROL-FREE, HIGH-LINOLEIC-ACID VEGETARIAN DIET ON SERUM LIPOPROTEINS OF CHILDREN WITH FAMILIAL HYPERCHOLESTEROLEMIA (TYPE II-A)

ABSTRACT. Fernandes, J., Dijkhuis-Stoffelsma, R., Groot, P. H. E., Grose, W. F. A. and Ambagtsheer, J. J. (Departments of Paediatrics and Clinical Chemistry, Sophia Children's Hospital, and the Department of Biochemistry I, Medical Faculty, Erasmus University, Rotterdam, The Netherlands). The effect of a virtually cholesterol-free, high-linoleic-acid vegetarian diet on serum lipoproteins of children with familial hypercholesterolemia (type II-A). Acta Paediatr Scand, 70:677,.–The effect of a virtually cholesterol-free, high-linoleic-acid vegetarian diet and a high-linoleic-acid "normal" diet with a moderate cholesterol content was tested in 39 children heterozygote for hypercholesterolemia type II-A. The diets were administered in an outpatient cross-over design of two periods of 10 weeks each and the serum lipoproteins were analyzed at the end of the two 10-week periods. The vegetarian diet induced a decrease in serum concentrations of LDL-II total and free cholesterol and of apo-B, by an average of 10 %, whereas HDL cholesterol and apo-A-I decreased by 4 %. The disproportionately large change in LDL compared to the small change in HDL was interpreted as an antiatherogenic effect of the vegetarian diet.