Showing papers in "Acta Paediatrica in 1979"

Effects on the child of alcohol abuse during pregnancy. Retrospective and prospective studies.

Abstract: . Olegard, R., Sabel, K.-G., Aronsson, M., Sandin, B., Johansson, P. R. Carlsson, C., Kyllerman, M., Iversen, K. and Hrbek, A. (Departments of Paediatrics, East Hospital, University of Goteborg and Psychiatric Clinic II and Nordhem Alcoholic Clinic, Lillhagen Hospital, Goteborg, Sweden). Effect on the child of alcohol abuse during pregnancy. Retrospective and prospective studies. Retrospective and prospective investigations of children to alcoholic women gave an incidence of fetal alcohol lesion of one per 300 deliveries of whom half had the complete fetal alcohol syndrome. Perinatal and infant mortalities were increased seven to tenfold and low birth weight (<2500 g), preterm deliveries (<37 weeks) and smallness for gestational age (<-2 S.D.) were increased eightfold, threefold and twelvefold, respectively. Small size at birth correlated with reduced mental performance later in life, 58% had IQ below 85 and 19% below 70. 8% had cerebral palsy. The incidence of cerebral palsy associated with maternal inebriety was 1/5000 deliveries, i.e. every sixth case of cerebral palsy. Tracing of alcoholic women during pregnancy and treatment gave favourable effect on intrauterine growth when sobriety could be induced early in pregnancy but could not protect from functional brain disturbance measured by neurological performance and by evoked response electroencephalography. Damage to the fetus by alcohol is now the largest known health hazard by a noxious agent that is preventable.

Prospective studies of the effect of breast feeding on incidence of infection and allergy.

Abstract: The effect of exclusive breast feeding in the first few weeks after birth on infant morbidity due to infectious and allergic disorders was investigated in three separate prospective studies. In a rural community in India, breast-fed infants had a significantly lower incidence of respiratory infection, otitis, diarrhoea, dehydration and pneumonia. In an urban population in Canada, breast feeding was associated with a marked decrease in the occurrence of otitis and respiratory disease and to a lesser extent of diarrhoea and dehydration. In newborn siblings of children with atopic disease exclusively breast-fed for a minimum of six weeks, the incidence of eczema, recurrent wheezing, elevated serum IgE-antibodies to cow's milk, complement activation in vivo after milk challenge and hemagglutinating antibodies to beta-lactoglobulin was significantly lower compared with formula-fed matched group. These observations provide clinical data attesting the immunologic advantages of human milk.

IgG SUBCLASS LEVELS IN INFANCY AND CHILDHOOD

Abstract: . Oxelius, V. (Department of Paediatrics, University Hospital, Lund, Sweden). IgG subclass levels in infancy and childhood. Acta Paediatr Scand, 68: 23, 1979.—The concentrations of IgG1, IgG2, IgG3 and IgG4 were determined by electroimmunoassay in 10 pairs of maternal and cord sera and in sera of 162 healthy children, aged 6 weeks to 15 years. Specific rabbit antisera against the IgG subclasses were used. The content of the normal serum pool WHO 67/97 was used as reference. The mean value, standard deviation and normal range of each IgG subclass were calculated for each age group and compared with the adult values. All IgG subclasses were present in cord serum except for IgG4 in those cases where also the maternal serum lacked demonstrable IgG4. The IgG subclasses followed the pattern of total IgG with a fall during the first 3–6 months and a subsequent gradual rise with age. The IgG1 and IgG3 levels rose faster with age than IgG2 and IgG4. Adult levels were not reached before puberty. No IgG4 was detectable in 12–21% of the children above 7 years of age.

Structural and functional abnormalities of the small intestine in infants and young children with rotavirus enteritis.

Abstract: Structural and functional alterations in duodenal mucosa from 17 children with rotavirus enteritis were assessed. Structural changes were found in specimens from all patients. Patients with the most severe mucosal damage were more likely to require intravenous therapy to correct dehydration. Depression of one or more mucosal disaccharidases was found in 14 of 16 patients. Repeat duodenal biopsy three to eight weeks later in six patients showed marked improvement. The study clearly shows that rotavirus can cause a marked structural and functional lesion in the upper small intestine which is rapidly reversible.

Gastric emptying in preterm infants.

Abstract: The gastric emptying of meals of human milk and infant formula was studied in 11 healthy preterm (AGA) infants at a postnatal age of 1-9 weeks corresponding to 33-38 weeks of gestational age. A total of 30 studies were performing using a marker dilution technique. Gastric emptying of meals of human milk followed a biphasic emptying pattern with an initial fast phase. In about 25 min half of the meal had left the stomach. The emptying of meals of adapted infant formula usually followed a linear pattern and half the meal had left the stomach after 51 min. After one hour an average of 24.8 ml of human milk and 19.2 ml of infant formula had left the stomach.

Pressure passive cerebral blood flow and breakdown of the blood-brain barrier in experimental fetal asphyxia.

Abstract: Cerebral blood flow (CBF) was studied in non-exteriorized near-term sheep fetuses using the radioactive microsphere technique. By partially occluding the umbilical vessels for a period of 1--1 1/2 hours a progressive and severe asphyxia with a final arterial pH of 6.90 was achieved. Varying the mean arterial blood pressure in the fetuses by blood withdrawal or infusion in this state, CBF was measured at different perfusion pressures (mean arterial blood pressure (MABP) minus central venous pressure (CVP)). A passive flow/pressure relationship--loss of autoregulation--was found, with hyperemia reaching CBF values up to 6 times normal at normal MABP of about 60 to 70 mmHg, and severe ischemia reaching CBF values close to zero in large cortical areas at MABP of 30 mmHg. CVP remained essentially unchanged at 10--15 mmHg. The severe and prolonged asphyxia rendered the blood-brain barrier leaky to the albumin tracer Evans blue. In four other fetuses umbilical cord clamping was omitted. However, only in one of these cases was acidosis completely avoided, and CBF autoregulation maintained. The three other fetuses were acidotic at the end of the surgical procedure and had impaired autoregulation.

Interactions of nutrition, infection and immune response. Immunocompetence in nutritional deficiency, methodological considerations and intervention strategies.

Abstract: . Clinical and epidemiologic data point to a causal interrelationship between nutritional deficiency and infectious illness. Both are major contributors to childhood morbidity and mortality, particularly in underprivileged population groups. Energy-protein undernutrition and deficiencies of iron, folates and pyridoxine, depress a variety of immunity functions. Delayed hypersensitivity and number of T lymphocytes are consistently reduced. In small-for-gestation low birth weight infants, cell-mediated immunity may remain depressed for several years. B lymphocytes, immunoglobulin levels and antibody responses are generally normal, but secretory IgA-antibody is reduced. Serum complement components are low and there is evidence of in vivo consumption of complement C 3. Neutrophil phagocytosis of bacteria and fungi is intact but the next step of intracellular killing is impaired. There are changes also in the production of lysozyme and interferon. Infection per se results in nutrient losses, either actual or by sequestration, and produces immunosuppression. The correction of postnatal nutritional deficits and/or infection is associated with reversal of immunological functions to normal. The interplay of nutrition, immunity and infection, and its biological implications are described.

Breast milk iron—a declining concentration during the course of lactation

Abstract: . Siimes, M. A., Vuori E. and Kuiunen P. (Children's Hospital and Department of Public Health Science, University of Helsinki, Helsinki, Finland). Breast milk iron—a declining concentration during the course of lactation. Acta Paediatr Scand, 68: 29, 1979.—The present investigation is the first longitudinal study of the concentration of iron in breast milk and is based on 229 milk samples obtained from 27 mothers during their period of lactation up to 9 months. The samples were collected at the beginning and at the end of each feed during a 24-h period to reflect as accurately as possible the actual concentration of iron. The median value declined during the course of lactation from 0.6 to 0.3 mg/l with a large range of values. The results indicate that the concentration is lower than is generally stated or is unusually low in Finnish mothers. As a consequence some infants may require iron supplementation during prolonged breast feeding although in general, the high bioavailability of breast milk iron prevents the development of iron deficiency.

THE CONCENTRATIONS OF COPPER AND ZINC IN HUMAN MILK A Longitudinal Study

Abstract: Twenty-seven healthy Finnish mothers were followed during the course of their entire lactation period. A total of 229 individual milk samples, collected in the beginning and at the end of each feed during a 24-h period, were obtained from the 2nd week to the 9th month of lactation. The copper and zinc concentrations were determined by atomic absorption spectrophotometry. The concentrations of the trace-elements investigated were dependent on the stage of lactation. The median copper and zinc concentrations decreased during the course of lactation from about 0.60 mg/l and 4.0 mg/l to 0.25 mg/l and 0.5 mg/l, respectively. The importance of considering the stage of lactation in the evaluation of the trace-element nutrition value of breast milk should be emphasized. The calculated means of the concentrations of these trace-elements in mature human milk presented in the literature seem to overestimate the actual levels in prolonged lactation.

Cow's milk allergy, incidence and pathogenetic role of early exposure to cow's milk formula.

Abstract: A study was performed in infants under the age of 12 months born during 1974 and admitted to St. Goran's Children's Hospital with symptoms suggestive of cow's milk allergy (CMA). The aims of the study were to determine the role of early exposure to cow's milk formulas as a predisposing factor to CMA and to estimate the incidence of CMA in infancy. Twenty-five infants fulfilled the criteria for CMA. Available records were reviewed and a careful history was obtained from the mothers on two occasions. The patient group was compared with a control group. Sixteen of the 25 infants were exposed to cow's milk protein during their first week in the nursery for newborns, 6 were exposed before the end of the fourth week of life, and 3 infants were apparently not exposed. All infants were breast fed 3 to 26 weeks before re-exposure and occurrence of symptoms. Infants with CMA were given cow's milk formulas during their first 4 weeks of life significantly more often than infants in the control group (p less than 0.01). The incidence of CMA was approximately 1 : 200. The first 4 weeks after birth seem to be a particularly vulnerable period. Hence, in order to prevent CMA, infant formula should not be given--even occasionally--during this period.

Neuropsychological Study in Treated Thyroid Dysgenesis

Abstract: . Wolter, R., Noel, P., De Cock, P., Craen, M., Ernould, Ch., Malvaux, P., Verstraeten, F., Simons, J., Mertens, S., Van Broeck, N. and Vanderschueren-Lodeweyckx, M. (Departments of Paediatrics, Universities of Brussels, Leuven, Ghent, Liege and Louvain, Belgium). Neuropsychological study in treated thyroid dysgenesis. Acta Paediatr Scand, Suppl. 277: 41, 1979.—Neuropsychological assessment was carried out in 57 patients aged 3.0 to 17.5 years (mean 8.5) with thyroid dysgenesis under adequate long-term therapy. Starting age of hypothyroidism as estimated by bone age at diagnosis was prenatal in 32 cases, close to birth in 13 cases and postnatal of 1–12 months in 12 cases. Hypothyroidism of prenatal onset results in severe neuropsychological disorders and mental retardation if not treated early. Only some signs of “minimal brain dysfunction” which compensate with advancing age and normal IQ are found in these children if therapy is started before one month of age. Hypothyroidism starting at birth does not result in mental retardation but neuropsychological disorders are found. They are more frequent if treatment is started after 6 months of age. Children who become hypothyroid between 1 and 12 months of age are usually not mentally retarded and show minor neuropsychological disorders.

Adrenocortical function in puberty. serum ACTH, cortisol and dehydroepiandrosterone in girls and boys.

Abstract: . Serum ACTH, Cortisol and dehydroepiandrosterone (DHEA) were determined in 200 girls and 80 boys. In girls, serum DHEA showed significant increases between all bone age groups from the youngest one, 7.5 years, to 12.5 years. A plateau was then seen up to 15.5 years of age, followed by a continuous increase to the oldest group (18.5 years). In boys, a progressive increase in DHEA was also seen from the youngest age group (8.5 years), but a period of a more rapid increase did not commence until after 12.5 years of age and it then continued to the oldest group. The level of DHEA in boys was significantly lower than in girls until the oldest group, in concert with the earlier pubertal development in girls. The importance of DHEA in initiating the early physical signs of normal puberty seems also to be different in the two sexes, since serum DHEA in girls was almost double that seen in boys, when compared according to the stage of pubic hair growth. Serum Cortisol showed a small progressive increase in girls, the concentrations postmenarche being significantly higher than premenarche. In boys, a decrease was seen up to 12.5 years of age and an increase occurred from 16.5 years onwards. In both sexes, ACTH and Cortisol levels showed an inverse but nonsignificant relationship to each other. Serum ACTH levels in the different age groups showed no significant changes.

Human colostral and breast milk cells. A light and electron microscopic study.

Abstract: Colostrum and breast milk samples were obtained from 74 women, 18 of whom gave sequential samples. The mean total leukocyte count in colostrum was 3190 cells/mm3. Proportions of macrophages, polymorphs and lymphocytes varied widely; macrophages usually predominated. Serial sampling showed (1) a small fall in total counts through delivery, (2) a fall in total counts and the proportion of PMNs at the onset of lactation, (3) after 1 to 2 weeks of lactation the appearance of cytoplasmic fragments together with epithelial cells which later constituted the main cell type. It was estimated that the total number of leukocytes available to the neonate remained approximately constant during the first 2 weeks of lactation and fell thereafter. Functionally, morphologically and histochemically macrophages in colostrum and breast milk resembled macrophages elsewhere. Their ultrastructure was characterized by filiform surface projections, numerous endocytic vacuoles and lipid droplets in the cytoplasm.

TRANSEPIDERMAL WATER LOSS IN NEWBORN INFANTS II. Relation to Activity and Body Temperature

Abstract: Using a method described in a previous article the transepidermal water loss (TEWL) was studied in 10 healthy newborn infants at rest and during activity. On the average TEWL was 37% higher during activity than during rest although no sweating was observed. In 9 infants placed in incubators with an ambient temperature slightly above the thermoneutral range measurements were made as the body temperature rose. TEWL was almost constant until a temperature of 37.1 degrees C was reached whereupon the water loss suddenly increased as the infant started sweating.

Reduced serum 1,25-(OH)2 vitamin D3 levels in prednisone-treated adolescents with systemic lupus erythematosus.

Abstract: . The serum levels of 1,25-(OH)2 vitamin D3 were assayed in samples from 12 adolescent patients with SLE. Subnormal levels were observed in 7 of these 12 patients. Low levels of the metabolically active polar metabolite of vitamin D3 may contribute to the development of osteopenia observed in this disease. The cumulative effects of the osteoporotic and anti vitamin D effects of long term steroid therapy in children with SLE may require the cautious administration of supplemental vitamin D.

A follow-up study of infants with adverse reactions to cow's milk. I. Serum IgE, skin test reactions and RAST in relation to clinical course.

Abstract: . 47 infants with cow's milk sensitivity were followed for a period varying between 6 months to 4 years (mean 28 months). The age at onset of symptoms varied between 14 days to 20 months. The clinical course was studied in relation to reaginic allergy by use of serum IgE, skin prick test and RAST. Infants with an immediate onset of symptoms from the gastrointestinal tract and the skin after cow's milk intake were discerned as a distinct entity having a high frequency of atopy in the family, positive skin tests and positive RASTs to milk (71%). Cases with delayed reactions to cow's milk seldom had a positive RAST or skin test. Most infants of both groups showed an increasing tolerance to milk. In RAST positive infants the RAST-titers increased significantly after onset of symptoms. After having reached a peak the titers subclined in several cases. The titers did not reflect the degree of milk sensitivity during the follow-up period. However, infants who developed high titers seemed to develop tolerance more slowly than infants with low titers.

Umbilical artery catheterization in newborns. I. Thrombosis in relation to catheter type and position.

Abstract: Seventy-one sick newborn infants, who had an umbilical artery catheterized, were randomized in one of four catheter groups: long end-hole-, short end-hole-, long side-hole- or short side-hole catheter. A long catheter means a high position of the catheter tip (Th6--11) and a short catheter a low position of the tip (L3--5). An angiography through the indwelling catheter in order to diagnose thrombosis was performed before the catheter was withdrawn. Dissection of the aorta and its brances was performed on infants who died. The total frequency of thromboses was 26%. There were no thromboses among infants with long end-hole catheters while infants with short end-hole catheters had thrombosis in 26%, long side-hole catheters in 33% and short side-hole catheters in 64%. Long end-hole catheters functioned better than the others. Only 6 of 16 infants with thrombosis had physical signs from the legs, while 12 infants without thrombosis had similar signs.

A prospective study of individual courses of breast feeding

Abstract: . A prospective study of the course of breast feeding was carried out in 75 randomly selected women. Weekly interviews were performed from the day after delivery until the termination of breast feeding, but in no case for longer than 6 months. In each case a detailed analysis was made of the factors leading to transient lactation crises or to complete cessation of breast feeding. A second group of 71 mothers, also randomly selected, was interviewed in retrospect only, 6 months after delivery, and served as controls. Twenty-four weeks after delivery 47% of the mothers in the weekly interview group were still breast feeding. The corresponding figure in the control group was 38%. In both groups only few mothers terminated lactation for medical reasons, while about one fourth stopped for some other reason and about one half because of a combination of factors. Brief case reports are presented to illustrate how varying the factors were that threatened breast feeding.

Prediction of adult height with various methods in finnish children

Abstract: . Successive height predictions were made by several methods for a group of healthy Finnish children (30 boys and 30 girls), examined annually at ages of 7 to 17 years (1st series) and for 7 boys aged 14 to 19 years with familial delayed growth and puberty (2nd series). The methods used were those of Bayley & Pinneau (BP), Walker (W), Tanner et al. (T) and RWT, and two simple principles: the relative height method (RH) which assumes constancy of height S.D.S. throughout growth, and the index of potential height (IPH) method which assumes constancy of height S.D.S. for bone age (BA). The predictions with RH, W and IPH were inaccurate. BP, T and RWT were for the 1st series as accurate as for the basic series of the respective methods, and none was superior to the others. The BA of average Finns was delayed as compared with the standards of Greulich-Pyle Atlas. When corrections were made for this delay, the IPH method gave predictions comparable in accuracy to BP, T or RWT. In the 2nd series prediction was more accurate with the corrected IPH, BP and RWT methods than with those using BA according to TW 2 RUS.

Growth in Turner's syndrome: spontaneous and fluoxymesterone stimulated.

Abstract: Spontaneous growth was analysed in a group of 55 girls with Turner's syndrome and various karyotypes Their variation in height and its dependence on parental height were similar to that of normal girls At all ages, the 45,X karyotype was associated with slightly greater mean stature than the other karyotypes together The bone ages lagged progressively behind from 10 years onwards Twenty-five patients aged between 91 and 172 years were given fluoxymesterone, 006-017 mg/kg daily, for at least 1 year Their height velocities increased significantly This brought about a clear psychological benefit Their final heights were predicted before and after therapy, with a new method based on the spontaneous growth and bone maturation of our patients The response was individually variable but, on average, the patients gained in predicted height from the therapy This effect was not lost during a posttreatment year Abnormal lowering of the voice occurred in patients receiving greater than or equal to 015 mg/kg fluoxymesterone daily, but never with less than 013 mg/kg No other adverse effects appeared Thus, fluoxymesterone is useful for promoting growth in girls with Turner's syndrome

The prognosis of near-drowned children.

Abstract: Thirty children were treated for near-drowning in the Children's Hospital, University of Helsinki during 1971--1976. The patients were divided into 3 groups according to the prognosis: group I included 13 children (43%) with a favourable prognosis, group II four children (13%) with a less favourable prognosis who developed severe sequelae, and group III 13 children with poor prognosis and in whom the subsequent outcome proved fatal. The surviving children underwent neurological, neurophysiological and psychological examination 6--58 months after the accident. The children in group I had slight neurological or psychological signs, some children presented a lowered intellectual functioning level. The children in group II were tetraplegic, unable to speak and had convulsions. The following factors were important in affecting prognosis: the longer the immersion time, the worse the prognosis. However, prognosis could still be favourable with an immersion-time of 11-20 min. Prognosis was bad if the first pH value was less than 7.00. The arterial oxygen pressure values measured during the treatment did not correlate with the prognosis but a low rectal temperature on admission was usually associated with a bad prognosis. The degree of EEG-disturbance had a prognostic value. However, the follow-up recording correlated better with the prognosis than the recordings during the first 24 hours, after which worsening of the EEG sometimes showed a progressive brain lesion. Language: en

Smoking during pregnancy--effects on the fetus and on thiocyanate levels in mother and baby.

Abstract: Twenty-eight mothers smoking 10--20 cigarettes daily during pregnancy had significantly higher serum thiocyanate concentrations at delivery compared in 25 non-smoking controls. The thiocyanate levels were positively correlated to cigarette consumption and inversely correlated to the birth weights of the infants. A highly significant correlation existed between serum thiocyanate levels of the mother and umbilical cord serum thiocyanate levels, reflecting a nearly complete equilibration. The thiocyanate concentrations in human milk on the 4th day after delivery were considerably lower than the serum concentrations, and no correlation existed between serum and milk concentrations. The infants of smoking mothers had significantly decreased weight and length at birth compared in infants of non-smokers. Birth weights were 3 344 +/- 434 g and 3 620 +/- 504 g respectively (p less than 0.05), and lengths 49.8 +/- 1.7 cm and 51 +/- 1.6 cm respectively (p less than 0.05). No differences were found between smokers and non-smokers in placental and umbilical cord histology, and umbilical cord artery medial area. It is concluded that serum thiocyanate concentration in smokers may be used as an objective measure for smoke exposure, and that maternal cigarette smoking acts as an exogenous factor which interferes with intrauterine development of the fetus in a dose related way.

A prospective study on the incidence and significance of congenital cytomegalovirus infection

Abstract: . Screening of 3060 neonates for congenital cytomegalovirus (CMV) infection by virus excretion in the urine showed an overall incidence of 0.4%. The incidence was about 1 % for mothers between 16 and 25 years and only 0.2% for mothers between 25 and 35. No mothers over 35 years of age gave birth to congenitally infected infants. The percentage of women in the child-bearing age susceptible to CMV infection was estimated by the absence of CMV complement-fixing antibodies in cord sera and ranged from 48% to 33% with increasing age. None of the infected infants showed obvious signs of congenital CMV infection at birth. At follow-up, two infants showed slight, but transient symptoms compatible with a foetal infection; a pair of premature twins exhibited retarded physical and psychomotor development, but this could just as well be ascribed to the prematurity itself. None of the infants had detectable CMV-IgM antibodies in cord sera, but a trend towards elevated total IgM concentration in cord sera and elevated virus excretion titres appeared in the infants with symptoms. With the very low incidence and no signs of sensomotor sequelae the preliminary conclusion is that foetal CMV infection in our population by no means has a significance to deserve routine screening or a vaccination programme.

Diagnostic value of symptoms and clean-voided urine specimen in childhood urinary tract infection.

Abstract: In diagnosing urinary tract infection (UTI) the symptoms of 477 infants and children and the findings in their clean-voided urine specimens were evaluated. 322 patients were considered infected, when a bacterial culture of suprapubic aspirate was used as a diagnostic reference. No diagnosis was attempted on the basis of symptoms only. Numerous bacteria or greater than or equal to 200 leuc./mm3 in an uncentrifuged clean-voided urine specimen or greater than or equal to 10(5) bact./ml in quantitative bacterial culture were found in 59%, 42% and 81% of the infected symptomatic patients. The diagnostic accuracies of these indices were 88%, 94% and 95%, respectively. In asymptomatic patients the accuracies were considerably lower. Among these infected patients normal or equivocal isolated findings in the clean-voided urine specimens were frequently seen, and could not markedly be reduced by the various related factors, such as technique of urine collection, urine specific gravity or pH of urine. None of the above mentioned indices of the clean-voided urine specimens seems to be alone accurate and sensitive enough for diagnosing UTI, and therefore these should be used in combination. The advantage of immediately obtaining results supports the use of urine microscopy as a primary diagnostic method in symptomatic UTI of childhood in particular.

Screening of cord blood low-density-lipoprotein cholesterol in the diagnosis of familial hypercholesterolaemia: a study of 2000 infants.

Abstract: A prospective follow-up study of infants selected by cord blood total cholesterol (TC) and low-density-lipoprotein cholesterol (LDL-C) levels from 2000 consecutive live births was undertaken to reassess the role of cord blood screening in the diagnosis of familial hypercholesterolaemia (FH). Mean values for serum cholesterol were (mmol/l +/- S.D.): TC, 1.83 +/- 0.56; LDL-C, 0.90 +/- 0.49; HDL-C, 0.70 +/- 0.33; TG, 0.38 +/- 0.16. Seventy-three of 117 infants who had had a cord TC and/or LDL-C greater than 95th percentile, and 373 control group children (cord TC and/or LDL-C less than 95th percentile) were followed up at age 3--12 months. Six of the 117 were hypercholesterolaemic (HC), and one child had an HC parent: positive detection rate greater than or equal to 0.05%; false positive rate greater than or equal to 3.7%. Four control-group children were HC and had an HC parent; false negative rate greater than or equal to 1.1%. With the possible exception of detecting FH in a child with a known affected parent, cord blood screening appears to be unreliable for the diagnosis of FH.

Benign paroxysmal torticollis in infancy

Abstract: . Benign paroxysmal torticollis is a condition characterized by attacks of head-tilting often accompanied by lateral curvature of the trunc. The first onset of these attacks usually occurs during the first months of life and they recur with a remarkable periodicity for 6–12 months after which time they gradually subside in intensity and frequency. As a rule the attacks have ceased completely before the age of 2 years but in some cases they continue in a modified form as attacks of ataxia. The aetiology is unknown and there is no evidence of bilateral peripheral vestibular disturbances as has been suggested in earlier reports. The ataxia seen in some cases rather suggests a dysfunction of the cerebellum or of the vestibulo-cerebellar connections. Four own patients with this syndrome are presented and discussed.

H2 breath tests during diarrhea.

Abstract: . The peak rise in breath hydrogen and the volume of excess pulmonary excretion of hydrogen in response to a 10 g dose of the non-absorbable disaccharide, lactulose, was significantly lower in children with active gastroenteritis and diarrhea than in non-diarrheal controls. Thus, despite the fact that the H2 breath test is a convenient, noninvasive technology for use in children, it cannot be recommended for measuring carbohydrate malabsorption in individuals with active, on-going episodes of diarrhea.

Umbilical artery catheterization in newborns. II. Infections in relation to catheterization.

Abstract: . Henriksson, P., Wesstrom, G. and Hedner, U. (Departments of Paediatrics, University of Lund, Allmanna Sjukhuset, Malmo and University Hospital, Linkoping, and The Coagulation Laboratory, Allmanna Sjukhuset, Malmo, Sweden). Umbilical artery catheterization in newborns. III. A study of some predisposing factors. Acta Paediatr Scand, 68: 719, 1979.—Thrombosis following umbilical artery catheterization is a relatively frequent complication. Low fibrinolytic activity in the vessel walls, high factor VIII and low antithrombin III (AT III, Heparin cofactor activity) in blood are factors known to favour the formation of thrombosis. In 30 newborns who died and in 2 foetuses the fibrinolytic activity determined in the aorta and the femoral vessels was in the normal ‘adult’ range except for a few very immature infants and the foetuses. The five cases with arterial thrombosis were not associated with low fibrinolytic activity. The various factor VIII activities (VIII: C, VIIIR: Ag, and VIIIR: RCF) and AT III were studied in 30 sick newborns and in 20 healthy newborns. The sick exhibited increased levels of various factor VIII activities (VIIIR: Ag and VIIIR: RCF mainly) and markedly reduced levels of AT III. The high factor VIII activities and the low AT III found will add to the existing risk of thrombosis due to the presence of a foreign material. AT III substitution is suggested as a possible prophylactic.

Screening for hyperlipoproteinemia in 10,000 Danish newborns. Follow-up studies in 522 children with elevated cord serum VLDL-LDL-cholesterol.

Abstract: Among 10 440 newborns, 522 with upper 5 percentile values for very low-low density lipoprotein cholesterol in cord serum were selected for follow-up studies. Follow-up was possible in 446 of these 522 families (85%) and familial hypercholesterolemia (FH) was diagnosed in 11. In 273 of the 522 children, serum lipids were determined between the ages of 1 and 2 years and were now found to be normal, except in the 11 children with FH. Furthermore the serum lipids were compared in subgroups of these 273 children divided according to obstetric complications (i.e. low birth-weight, perinatal asphyxia and antepartum betamethasone treatment), which may cause a rise in serum lipids at birth. No differences were found between these subgroups at the age of 1--2 years.