CBT for childhood anxiety disorders: differential changes in selective attention between treatment responders and non‐responders

Background: This study examined whether treatment response to stepped‐care cognitive‐behavioural treatment (CBT) is associated with changes in threat‐related selective attention and its specific components in a large clinical sample of anxiety‐disordered children. Methods: Ninety‐one children with an anxiety disorder were included in the present study. Children received a standardized stepped‐care CBT. Three treatment response groups were distinguished: initial responders (anxiety disorder free after phase one: child‐focused CBT), secondary responders (anxiety disorder free after phase two: child–parent‐focused CBT), and treatment non‐responders. Treatment response was determined using a semi‐structured clinical interview. Children performed a pictorial dot‐probe task before and after stepped‐care CBT (i.e., before phase one and after phase two CBT). Results: Changes in selective attention to severely threatening pictures, but not to mildly threatening pictures, were significantly associated with treatment success. At pre‐treatment assessment, initial responders selectively attended away from severely threatening pictures, whereas secondary responders selectively attended toward severely threatening pictures. After stepped‐care CBT, initial and secondary responders did not show any selectivity in the attentional processing of severely threatening pictures. Treatment non‐responders did not show any changes in selective attention due to CBT. Conclusions: Initial and secondary treatment responders showed a reduction of their predisposition to selectively attend away or toward severely threatening pictures, respectively. Treatment non‐responders did not show any changes in selective attention. The pictorial dot‐probe task can be considered a potentially valuable tool in assigning children to appropriate treatment formats as well as for monitoring changes in selective attention during the course of CBT.     

Implementation of a multidisciplinary guideline‐driven approach to the care of the extremely premature infant improved hospital outcomes

Aim: To test the hypothesis that implementing guidelines for the standardized care of the extremely premature infant (<27 weeks) in the first week of life would improve patient outcomes in an all referral NICU. Methods: Data were collected on all infants <27 weeks gestational age and <7 days of age on admission cared for using these small baby guidelines (SBG), as well as on all age‐matched infants admitted the year prior (comparison). Results: Thirty‐seven patients were cared for utilizing the SBG and 40 patients were in the comparison group. There were no differences between the groups in gestational age, birthweight or age on admission. There was no difference in survival to discharge (73% SBG, 70% comparison). The mean length of stay for survivors was 112 ± 38 days SBG and 145 ± 76 days (p < 0.05) comparison group. Survival without BPD was greater in the SBG group (24%) than in the comparison group (9%; p < 0.05), and survival without severe IVH was greater in the SBG group (65%) than in the comparison group (38%; p < 0.01). Conclusions: These data demonstrate that applying a unified approach to the care of the extremely premature infant in the first week of life resulted in a decrease in the length of hospitalization and improved patient outcomes.     

New Danish reference values for height,weight and body mass index of children aged 0–5 years

Aim: To derive new reference values for height, weight and body mass index (BMI) of children aged 0–5 years in Denmark and to compare them with the national reference from the 1970s and the 2006 WHO standard. Methods: The height and weight of 4105 healthy singleton children born in 1995 were obtained from a cohort study. Children were measured at birth and at seven regular health examinations by a general practitioner up to 5 years of age. Generalized additive models for location, scale and shape were used to construct percentile curves. Results: Mean length, weight and BMI at birth and during the first months of life increased significantly, but the differences diminished thereafter, and at 1 year BMI had decreased. In boys, weight and BMI had decreased by 2 years of age but had increased, together with height, at 5 years. Children were taller, heavier and had a higher BMI than that referred to in the WHO standard. Conclusion: New references for length or height, weight and BMI by age were constructed for children in Denmark. Since the 1970s, weight, length and BMI at birth increased, and growth during the first year of life appears to be healthier.     

Botulinumtoxin A treatment in toddlers with cerebral palsy

Aims: In this study the aim was to evaluate the effect of botulinum toxin A (BoNT‐A) treatment on muscle tone, contracture development and gait pattern in young children with cerebral palsy (CP). Method: Fifteen children with spastic CP (mean age = 16 months) were included in a randomized control study. All received a daily stretching programme and children in the BoNT‐A group additionally received two injections, 6 months apart in the gastrocnemius muscle. Outcomes were assessed at baseline, and after 1 and 3.5 years. A 3D gait‐analysis was performed at 5 years of age. Results: Plantarflexor muscle tone in the BoNT‐A group was significantly reduced after 3.5 years, while the muscle tone at the ankle and knee in the control group remained unchanged. The change‐score in knee‐flexion muscle tone between the groups was significantly different after 3.5 years. The knee joint ROM was significantly increased at 1 year in the BoNT‐A group but reduced at the knee and ankle joints in the control group after 3.5 years. No group differences were found for gait analysis, GMFM‐66 or PEDI. Conclusion: Early treatment of BoNT‐A in children with spastic CP may decrease muscle tone and decelerate contracture development after 3.5 years. The effect on gait development remains inconclusive.     

Cellular infiltration and cytokine mRNA expression in perennial allergic rhinitis

BACKGROUND: Allergen challenge in allergic rhinitis patients leads to local eosinophilia and Th2-type cytokine expression. Natural exposure to grass pollen is additionally characterized by epithelial mast-cell infiltration. We hypothesized that perennial allergic rhinitis is also associated with T-cell and eosinophil infiltration of the nasal mucosa, local Th2-type cytokine expression, and increased numbers of nasal epithelial mast cells. METHODS: Nasal biopsies from perennial allergic rhinitis patients and controls were analysed by immunocytochemistry for different cell populations and in situ hybridization for cytokine mRNA-expressing cells. RESULTS: Perennial allergic rhinitis was associated with increased numbers of submucosal CD3+ T cells (P=0.05), EG2+ activated eosinophils (P=0.01), and CD68+ macrophages (P=0.01) compared to controls. Epithelial, but not submucosal, tryptase-positive mast cells were also elevated in rhinitics compared to controls (P=0.01). The numbers of cells expressing interleukin (IL)-5 were higher (P=0.01) and the numbers of cells expressing IL-2 were lower (P=0.04) in rhinitic patients than controls. There were no significant differences for either IL-4 or interferon-gamma between the groups. CONCLUSIONS: Perennial allergic rhinitis is characterized by mast-cell migration into the epithelium; submucosal infiltration by T cells, eosinophils, and macrophages; and an imbalance in local T-cell cytokine production in favour of enhanced IL-5 and reduced IL-2 expression.     

Pancreatic necrosis: CT manifestations

Pancreatic necrosis is a potential sequela of acute pancreatitis, which pathologically represents a collection of devitalized tissue. Appropriate therapeutic planning requires definition of this irreversibly damaged gland, the presence of which is not consistently diagnosed on the basis of clinical and laboratory data. Over an 18-month period, 22 patients with pancreatic necrosis were studied by one or more computed tomographic (CT) examinations. Retrospective analysis showed the findings to vary with the developmental stage of the necrotizing process. During the acute phase, there was considerable morphologic overlap of necrosis and pancreatic phlegmon. Typical findings were seen in the subacute and chronic stages and included diffuse enlargement of the gland with largely decreased central density. A thick, smooth surrounding rim produced a characteristic saclike configuration. CT-guided aspiration for culture material was performed in four patients with suspected superinfection. Negative gram stain and culture results in two patients allowed surgery to be performed on a more elective basis.