A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants in the Netherlands: its incidence, clinical characteristics, treatment and outcome

Aims: To estimate the incidence and clinical characteristics in hospital admissions due to dehydration or undernutrition and their laboratory evaluation and treatment outcome in exclusively breastfed infants.
Methods: All hospital admissions during the first 3 months of life assessed by the Dutch Paediatric Surveillance Unit (DPSU) between mid 2003 and mid 2005.
Results: Nationwide 158 cases reported, correspond to an incidence of 58/y/100 000 breastfed infants; it is lower for severe dehydration at risk for hypernatraemia; 20/y/100 000. Sixty-five per cent of cases were <2 weeks old, their median weight loss was 9.3% and median age at admission 5 days; Serum sodium value was measured in only 12% of all cases. Insufficient volume intake and inadequate growth were most frequently reported (61% and 41%). Lethargy, jaundice or clinical dehydration was scored in 11–25%, seizures or shock in 3%. A breast pump at home was used in only 31%. In the hospital breast pumps were available (82%) as lactation consultants (73%). For treatment 65% was offered formula, in 30% by nasogastric drip. Most admissions lasted up to 3 days, all recovered fully and 33% were breastfed exclusively at discharge.
Conclusion: The incidence of severe dehydration in the Netherlands is relatively low. With extended use of breast pumps at home it could be lower. To prevent complications, we recommend applying a reference weight chart, a full clinical examination and more extensive screening of serum sodium and glucose.     

4‐Thio‐deoxyuridylate‐modified thrombin aptamer and its inhibitory effect on fibrin clot formation,platelet aggregation and thrombus growth on subendothelial matrix

Summary. Background: The consensus thrombin aptamer C15‐mer is a single‐stranded DNA of 15 nucleotides [d(GGTTGGTGTGGTTGG)] that was identified by the selection of thrombin‐binding molecules from a large combinatorial library of oligonucleotides. It is capable of inhibiting thrombin at nanomolar concentrations through binding to a specific region within thrombin exosite 1. As has been shown in our earlier studies, the 4‐thio‐deoxyuridylate (s4dU)‐containing oligonucleotides have high affinity for a number of proteins, due to the reduced hydrophilic character of the modified oligonucleotide. Methods: Three different analogs of the original thrombin‐inhibiting sequence, in which some of the thymidylate residues were replaced by 4‐thio‐deoxyuridylates, were synthesized. The inhibitory effect of modified aptamers was tested on thrombin‐catalyzed fibrin clot formation and fibrinopeptide A release from fibrinogen, thrombin‐induced platelet aggregation/secretion, and the formation of thrombus on coverslips coated with human collagen type III, thrombin‐treated fibrinogen or subendothelial matrix of human microvascular endothelial cells. Results: As compared with the C15‐mer, the analog with the sequence GG(s4dU)TGG(s4dU)G(s4dU)GGT(s4dU)GG (UC15‐mer) showed a 2‐fold increased inhibition of thrombin‐catalyzed fibrin clot formation, fibrinopeptide A release, platelet aggregation and secretion in human plasma and thrombus formation on thrombin‐treated fibrinogen surfaces under flow conditions. Concerning the inhibition of thrombin‐induced fibrin formation from purified fibrinogen and activation of washed platelets, UC15‐mer was 3‐fold and twelve‐fold more effective than C15‐mer, respectively. Conclusion: The replacement of four thymidylate residues in C15‐mer by 4‐thio‐deoxyuridylate resulted in a new thrombin aptamer with increased anticoagulant and antithrombotic properties.     

Incidence and predictors of atopic dermatitis in an open birth cohort in Sisimiut, Greenland

The frequency of atopic dermatitis (AD) is unknown among children in Greenland. To determine the incidence of AD and to identify risk factors for onset of AD within the first 2 y of life among Greenlandic children an open cohort of 143 children aged 0-2 y in Sisimiut, West Greenland, was followed for a median of 335 d. The children were visited on a weekly basis, where clinical examinations revealed any cases of AD. In total, 24 of the 143 children developed AD. The incidence rate of AD was 177 cases per 1000 child years at risk, corresponding to a cumulative risk of 16% per year. Maternal history of AD \[hazard ratio (HR) 2.6, 95% confidence interval (CI) 1.03-6.57], high social class of the family (HR 6.18, CI 2.19-17.41) and living in a detached house compared with living in a terraced house or an apartment (HR 2.81, CI 1.16-6.28) were associated with increased risks of AD. In a multivariate model these risk factors all remained significant.     

EFFECT OF HOMOCYSTEINE ON THE PRODUCTION OF NITRIC OXIDE IN ENDOTHELIAL CELLS

1. Homocysteine decreased the release of nitric oxide in cultured human umbilical vein endothelial cells. 2. Homocysteine did not affect constitutive and inducible nitric oxide synthase activity.