Showing papers in "Acta Paediatrica in 1996"

Intrauterine growth curves based on ultrasonically estimated foetal weights.

Abstract: Available standard intrauterine growth curves based on birthweights underestimate foetal growth in preterm period. New growth curves are presented based on data from four Scandinavian centres for 759 ultrasonically estimated foetal weights in 86 uncomplicated pregnancies. Mean weight of boys exceeded that of girls by 2-3%. A uniform SD value of 12% of the mean weight was adopted for the standard curves as the true SD varied non-systematically between 9.1 and 12.4%. Applied to an unselected population of 8663 singleton births, before 210 days of gestation, 32% of birthweights were classified as small-for-gestational age (SGA; i.e. below mean - 2 SD); the corresponding figures were 11.1% for gestational ages between 210 and 258 days, and 2.6% for ages of 259 days or longer. The new growth curves reveal better the true distribution of SGA foetuses and neonates, and are suggested for use in perinatological practice.

The changing panorama of cerebral palsy in Sweden. VII : Prevalence and origin in the birth year period 1987-90

Abstract: This seventh Swedish population-based cerebral palsy (CP) report comprises 216 children born between 1987 and 1990 The crude live birth prevalence was 236 per 1000, indicating a break in the continuous increase since 1970 Excluding 10 postnatally-derived cases, gestational-age specific prevalences were 80 for extremely, 54 for very and 8 for moderately preterms and 14 for term children per 1000 Birth weight-specific prevalences were 57 for birth weights or = 2500 g per 1000 The aetiology was considered prenatal in 8%, peri/neonatal in 54% and unclassifiable in 38% of preterms and 33, 28 and 39% of term children Hemiplegic, diplegic and tetraplegic syndromes accounted for 22, 66 and 7% of preterms and 44, 29 and 10% of term children Non-walking, mental retardation, epilepsy, severe visual impairment and infantile hydrocephalus were present in 39, 39, 26, 18 and 23% of preterms; and 38, 44, 36, 14 and 5% of term children, respectively The entire series of 1408 cases born in 1954-90 revealed three distinct trend eras for preterms, clearly related to changes in perinatal care and shifts in type of CP manifestations

The coeliac iceberg in Italy. A multicentre antigliadin antibodies screening for coeliac disease in school‐age subjects

Abstract: Background Recent studies suggest that coeliac disease (CD) is one of the commonest, life-long disorders in Italy. The aims of this multicentre work were: (a) to establish the prevalence of CD on a nationwide basis; and (b) to characterize the CD clinical spectrum in Italy. Patients and methods Fifteen centres screened 17,201 students aged 6-15 years (68.6% of the eligible population) by the combined determination of serum IgG- and IgA-antigliadin antibody (AGA) test; 1289 (7.5%) were IgG and/or IgA-AGA positive and were recalled for the second-level investigation; 111 of them met the criteria for the intestinal biopsy: IgA-AGA positivity and/or AEA positivity or IgG-AGA positivity plus serum IgA deficiency. Results Intestinal biopsy was performed on 98 of the 111 subjects. CD was diagnosed in 82 subjects (75 biopsy proven, 7 not biopsied but with associated AGA and AEA positivity). Most of the screening-detected coeliac patients showed low-grade intensity illness often associated with decreased psychophysical well-being. There were two AEA negative cases with associated CD and IgA deficiency. The prevalence of undiagnosed CD was 4.77 x 1000 (95% CI 3.79-5.91), 1 in 210 subjects. The overall prevalence of CD, including known CD cases, was 5.44 x 1000 (95% CI 4.57-6.44), 1 in 184 subjects. The ratio of known to undiagnosed CD cases was 1 in 7. Conclusions These findings confirm that, in Italy, CD is one of the most common chronic disorders showing a wide and heterogeneous clinical spectrum. Most CD cases remain undiagnosed unless actively searched.

Abnormal intestinal permeability in children with autism.

Abstract: We determined the occurrence of gut mucosal damage using the intestinal permeability test in 21 autistic children who had no clinical and laboratory findings consistent with known intestinal disorders. An altered intestinal permeability was found in 9 of the 21 (43%) autistic patients, but in none of the 40 controls. Compared to the controls, these nine patients showed a similar mean mannitol recovery, but a significantly higher mean lactulose recovery (1.64% +/- 1.43 vs 0.38% +/- 0.14; P < 0.001). We speculate that an altered intestinal permeability could represent a possible mechanism for the increased passage through the gut mucosa of peptides derived from foods with subsequent behavioural abnormalities.

Generalized lipodystrophy, congenital and acquired (lipoatrophy)

Abstract: This review is based on longitudinal studies on our seven patients with congenital generalized lipodystrophy, our patient with acquired generalized lipodystrophy, and published papers on these subjects. An inability to store energy in adipose tissue is of pathogenetic importance. In congenital lipodystrophy, insulin resistance is present from birth, resulting in hyperinsulinaemia, dyslipidaemia. and insulin-resistant diabetes with an anabolic syndrome worsened by a voracious appetite. Clinically, we observed increased height velocity in pre-school age children, and organomegaly with hypertrophic cardiomyopathy, which seems to be lethal in early adulthood: three of our patients died at the ages of 24, 32 and 37 years. The oldest alive, 39 years, suffers from stenocardia. Regarding treatment, it is most important to reduce energy consumption. The congenital form is recessively inherited. The aetiology may be related to insulin receptor or postreceptor mechanisms. Acquired generalized lipodystrophy seems to be an autoimmune disorder with secondary destruction of the adipose organ: the anabolic syndrome with insulin-resistant diabetes is secondary. Our patient died when 24 years old from pneumonia.

Etiology and pathogenesis of attention-deficit hyperactivity disorder (ADHD): significance of prematurity and perinatal hypoxic-haemodynamic encephalopathy.

Abstract: Attention-deficit Hyperactivity Disorder (ADHD), defined as a disorder of awareness with impulsivity, has lately been characterized as a dysfunction of the striatum (neostriatum = globus pallidus + putamen). This structure is in a unique position of contextual analysis and samples information samples information from almost the entire cortex through its spiny neurons. The etiology is heterogeneous, with genetic as well as lesional factors. Among the latter, pre- and perinatal events are prominent. Advances in the understanding of the role of fetal circulatory insufficiency with loss of autoregulation and systemic hypotension have drawn attention to the vulnerability of watershed regions, including the striatum. Not only circulatory facts are important for this selectivity, however. The anatomical characteristics, with convergent glutaminergic afferent synaptic transmission from almost the entire cortex contribute to the vulnerability in ischemia-induced liberation of glutamate: The striatum becomes the victim of its virtue. Repeated hypoxic-ischemic events are particularly common in prematurity, a fact which seems to explain the high incidence of ADHD in this patient group. The magnitude, of the problem is increasing with the increased survival rate among premature infants.

Mechanisms of tissue injury by oxygen radicals: implications for neonatal disease.

Abstract: A role of the oxygen radical generating system hypoxanthine-xanthine oxidase in hypoxia-reoxygenation injury was proposed 15 years ago. In recent years, however, new understanding of hypoxia-reoxygenation injury has been achieved and the significance of other oxygen radical generating systems has been acknowledged too. The hypothesis that an oxygen radical disease exists in preterm infants has recently been strengthened; an important observation is that preterm infants have lower activities of erythrocyte Cu/Zn superoxide dismutase compared to term babies. New actions of oxygen radicals have also been emphasized, and recently it has been demonstrated that the degree of protein oxidation of the lung of newborn infants is associated with chronic lung injury. The new insight into the interaction of oxygen radicals with other systems as excitatory amino acids and the NO system also increases the possibility to understand and hence prevent oxygen radical injury in the preterm infant as well as in adults exposed to an increased load of oxygen radicals.

Effects of a dietary and environmental prevention programme on the incidence of allergic symptoms in high atopic risk infants: three years follow‐up

Abstract: A prospective case-control study is presented to assess an allergy prevention programme in children up to 36 months of age. Infants born at three maternity hospitals were followed from birth: 279 infants with high atopic risk (intervention group) were compared with 80 infants with similar atopic risk but no intervention (non-intervention group). The intervention programme included dietary measures (exclusive and prolonged milk feeding diet followed by a hypoantigenic weaning diet) and environmental measures (avoidance of parental smoking in the presence of the babies, day care > 2 years of life). Mothers in this group who had insufficient breast milk were randomly assigned to one of two coded formulas: either a hydrolysed milk formula (Nidina HA, Nestle) or a conventional adapted formula (Nan, Nestle). Other environmental measures remained the same as for the breastfeeding mothers. The non-intervention group were either breastfed or received the usual Italian milk feeding and weaning diet, without environmental advice. The main outcome measures were anthropometric measurements and allergic disease manifestations. Normal anthropometric data were observed both in the intervention group and in the non-intervention group. The incidence of allergic manifestations was much lower in the intervention group than in the non-intervention group at 1 year (11.5 versus 54.4%, respectively) and at 2 years (14.9 versus 65.6%) and 3 years (20.6 versus 74.1%). Atopic dermatitis and recurrent wheezing were found in both the intervention group and the non-intervention group from birth up to the second year of life, while urticaria and gastrointestinal disorders were only present in the non-intervention group in the first year of life. Conjunctivitis and rhinitis were present after the second year in both the intervention group and the non-intervention group. Relapse of the same allergic symptom was less in the intervention group (13.0%) than in the non-intervention group (36.9%). In comparison to the non-intervention group, there were fewer intervention group cases with two or more different allergic symptoms (8.7 versus 32.6%), and they were more likely to avoid steroid treatment (0 versus 10.8%) and hospital admission (0 versus 6.5%). Babies in the non-intervention group fed with adapted formula were more likely to develop allergies than breastfed babies in the same group. In the intervention group the breastfed infants had the lowest incidence of allergic symptoms, followed by the infants fed the hydrolysed formula (ns). Infants in the intervention group fed the adapted formula had significantly more allergies than the breastfed and hydrolysed milk fed infants, although less than their counterparts in the non-intervention group. Of the affected subjects in the intervention group, 80.4% were RAST and/or Prick positive to food or inhalant allergens. Total serum IgE values detected at birth in the intervention group were not predictive, but at 1 and 2 years of age, IgE values more than 2 SD above the mean in asymptomatic babies were found to predictive for later allergy. In breastfed babies the total IgE level at 1 and 2 years of age was lower than in the other two feeding groups. Of the various factors tested in the non-intervention group, the following were the most important in the pathogenesis of allergic symptoms: (i) formula implementation begun in the first week of life; (ii) early weaning (< 4 months); (iii) feeding beef (< 6 months); (iv) early introduction of cow's milk (< 6 months); and (v) parental smoking in the presence of the babies and early day care admission (< 2 years of life). All the preventive measures used in this study (exclusive breastfeeding and/or hydrolysed milk feeding, delayed and selective introduction of solid foods, and environmental advice) were effective at the third year of follow-up, greatly reducing allergic manifestations in high atopic risk babies in comparison with those not receiving these interventions

Autosomal recessive polycystic kidney disease in 115 children: clinical presentation, course and influence of gender

Abstract: The clinical course of 66 boys and 49 girls with autosomal recessive polycystic kidney disease recruited from departments of paediatric nephrology was investigated over a mean observation period of 4.92 years. This is a selected study group of children from departments of paediatric nephrology who in most cases survived the neonatal period, since birth clinics did not participate. The median age at diagnosis was 29 days (prenatal to 14.5 years). We observed decreased glomerular filtration rates (GFRs) in 72% (median age at onset of decrease of GFR < 2 SD, 0.6 years; range, 0-18.7 years), and 11 patients developed end-stage renal disease. Hypertension requiring drug treatment was found in 70% (median age at start of medication, 0.5 years; range, 0-16.7 years). Kidney length was above the 97th centile in 68% of patients, and kidney length did not increase with age or deterioration of renal function. Urinary tract infections occurred in 30%, growth retardation in 25%, and clinical signs of hepatic fibrosis were detected in 46%. Thirteen patients (11%) died during the observation period, 10 of them in the first year of life. There was a statistically significant sex difference in terms of a more pronounced progression in girls. The survival probability at 1 year was 94% for male patients and 82% for female patients (p < 0.05) in this study. Urinary tract infections occurred more frequently in girls (p < 0.025) and were observed earlier. In addition, more girls had impaired renal function, developed end-stage renal disease and showed growth retardation; these differences, however, were not significant. For the children in this study, however, our results indicate that the long-term prognosis in the majority of cases is better throughout childhood and youth than often stated.

Breastfeeding: physiological, endocrine and behavioural adaptations caused by oxytocin and local neurogenic activity in the nipple and mammary gland.

Abstract: It is now well established that oxytocin, as well as stimulating uterine contractions and milk ejection, promotes the development of maternal behaviour and also bonding between mother and offspring. In addition, oxytocin exerts by way of peripheral, circulating as well as by central, neurogenic mechanisms multiple physiological, endocrine and behavioural effects in connection with milk ejection and lactation. Some effects of oxytocin in the nipple and mammary gland appear to be exerted in close collaboration with peptides released from axon collaterals of somatosensory nerves originating in this region. The distribution of peptides localized to the somatosensory afferents in the nipple and mammary gland as well as possible effects by oxytocin and/or local neurogenic peptides in connection with milk ejection and lactation are reviewed in this paper.

Food habits and energy and nutrient intake in Swedish adolescents approaching the year 2000.

Abstract: In 1993-94 a nutritional survey of 15-year-old adolescents was carried out in Uppsala, a university city in eastern Sweden, and in Trollhattan, an industrial town in the western part of the country. The study was the beginning of a longitudinal nutritional survey of 193 boys and 218 girls randomly selected from the official population register. The dietary methods used were a food frequency questionnaire (FFQ) and a combined estimated and weighed 7-day dietary record. According to the FFQ both boys and girls consumed cereals, butter or margarine and something from the group meat/fish/eggs every day. Milk, milk products, sweets and snacks were consumed more than once per day. Vegetables and fruit/ roots were consumed less often. There was relatively good correlation between the FFQ and the 7-day record results. The mean daily energy intakes of the 15-year-old boys and girls were 10.2 and 8.3 M J, respectively, in Uppsala, and 9.8 and 7.4 M J in Trollhattan. The mean daily intakes of sucrose were 74 and 58 g in boys and 64 and 52 g in girls. The average daily dietary fibre intake was 1.8 g/MJ. The daily intake of energy obtained from breakfast was 18% on weekdays and 22% on weekends; 18 and 11% from prepared lunch; 24 and 30% from dinner, 21 and 14% from light meals; and 16 and 28% from snacks, in Uppsala and Trollhattan respectively. The lowest energy intake from a prepared lunch meal was noted during weekends. On both weekdays and weekends, considerable energy was obtained from light meals and snacks. However, nearly 40% of the girls and 28% of the boys had an energy intake from fat of Ylt; 30 energy %. The mean intakes of vitamin D and selenium and, in the case of girls, iron and zinc, were below the official Swedish Nutrition Recommendations. The daily median intake of iron was 18.7 mg in boys and 14.1 mg in girls. The iron intakes varied between 6 and 35 mg per day. Low serum ferritin concentrations, defined as s-ferritin <12μg/L, were found in 7 boys (3.7%) and in 29 girls (13.9%). Significant negative correlations were found between smoking and frequency of consumption of vegetables, roots, fruits and meat. A negative correlation was also found between smoking and the intake of energy and a number of nutrients. Socioeconomic factors seem to be less important for the food habits of teenagers than for those noted during childhood. Only frequent consumption of vegetables was positively correlated to the mothers’educational level.

Decreased thymus size in formula-fed infants compared with breastfed infants

Abstract: The objective of this research was to investigate if breastfeeding affects the size of the thymus. Ultrasound assessment of the thymic index (a volume estimate) at birth and age 4 months in 47 healthy infants born in the hospital were used. History of feeding mode, body size and illness were registered. At 4 months the geometric mean thymic index (range) was 38.3 (16.2-83.2) in exclusively breastfed infants (11 = 21), 27.3 (15.6-50.0) in partially breastfed infants (n = 13) and 18.3 (12.2-32.6) in formula fed infants (n = 13 ; p = 0.0001. ANOVA). This finding was independent of weight, length, sex and previous or current illness. There was no significant difference in mean thymic index at birth between the three feeding groups and mean thymic index had increased in all three groups from birth to 4 months. For the formula-fed infants it seems that the thymus remains large for a period and then decreases in size after breastfeeding has been terminated. We conclude that the thymus is considerably larger in breastfed than in formula-fed infants at the age of 4 months. The cause of this difference is unknown but human milk contains many immune modulating factors that might cause this effect.

Feeding and nutritional characteristics in children with moderate or severe cerebral palsy

Abstract: This study was undertaken to characterize the current feeding situation and nutritional status of moderately or severely disabled children with cerebral palsy (CP). Thirty-five children with CP (17 with diplegia, 11 with dystonia, 6 with tetraplegia and one child with ataxia) were investigated at a median age of 8 years. Information was obtained from parental interviews, medical records and clinical and anthropometric examinations. Twenty-one of the 35 children (60%), most of whom were severely disabled, were reported by the parents to have current feeding problems. Anthropometric indicators of undernutrition were found in 15 children (43%) and of overnutrition in 3 children (9%), compared with reference values of healthy children. Severely disabled children in the youngest age group were most at risk for poor nutritional status. Early identification of children at nutritional risk requires regular assessments of feeding skills and nutritional status.

Urinary excretion of lactose and oligosaccharides in preterm infants fed human milk or infant formula.

Abstract: At present, not much is known about the absorption and metabolism of human milk (HM) oligosaccharides in term and preterm infants. We investigated the renal excretion of lactose and complex oligosaccharides in preterm infants fed HM (n = 9, mean actual body weight 2290 g) or a cow's milk-based infant formula (n = 9, mean actual body weight 2470 g). We found that the renal excretion of lactose in HM-fed infants was slightly lower than in formula-fed infants (14.0 +/- 7.4 versus 20.4 +/- 8.7 mg kg-1 day-1, mean +/- SD). The excretion of neutral sugars deriving from oligosaccharides was similar in HM-fed and formula-fed infants (3.8 +/- 2.1 versus 2.9 +/- 0.9 mg kg-1 day-1); the difference between means was not statistically significant. The separation and characterization of oligosaccharides by high-pH anion exchange chromatography with pulsed amperometric detection (HPAE-PAD) and subsequent analysis by fast atom bombardment-mass spectrometry (FAB-MS) revealed a more complex pattern in HM-fed infants compared to the formula-fed group. Lactose-derived oligosaccharides characteristic for HM (e.g. lacto-N-tetraose, and lacto-N-fucopentaoses I and II) were excreted in HM-fed but not in formula-fed infants. These results indicate that nutrition has a significant impact on the oligosaccharide composition in urine of preterm infants.

Fetal memory: Does it exist? what does it do?

Abstract: Whether fetal memory exists has attracted interest for many thousands of years. The following review draws on recent experimental evidence to consider two questions: does the fetus have a memory? And, if so, what function(s) does it serve? Evidence from fetal learning paradigms of classical conditioning, habituation and exposure learning reveal that the fetus does have a memory. By comparison little attention has been paid to the possible function of memory. Possible functions discussed are: practice, recognition of and attachment to the mother, promotion of breastfeeding, and language acquisition. It is concluded that the fetus does possess a memory but that more attention to the functions of fetal memory will guide future studies of fetal memory abilities.

The natural history of cardiac rhabdomyoma with and without tuberous sclerosis.

Abstract: The aim of the present study is to contribute to the knowledge of the natural history of cardiac rhabdomyoma in children with and without tuberous sclerosis. In a retrospective study, 33 children with cardiac rhabdomyoma were collected from three pediatric cardiology centres. In 30/33 patients tuberous sclerosis was associated. High prevalence of cardiac rhabdomyoma was found in infancy, with 21/23 detected before the age of 1 year, and 11/33 before 1 month of age. Cardiac manifestations were present in 19 patients: cardiac rhythm disturbances were detected in 13; in 6/33 a Wolff-Parkinson-White syndrome was documented, of which 4 presented paroxysmal arrhythmias. Obstructive or regurgitative phenomena were present in 5; and in 2 patients surgical removal proved necessary. With the exception of one tumoural mass in the right atrium, all 77 tumours were located somewhere in the ventricles, including at atrio-ventricular valve level. Because of spontaneous regression of most of the tumoural masses, treatment should at first be symptomatic, while surgical removal is required only in life-threatening conditions, as documented in 2 of our 33 patients.

Amphetamine addiction during pregnancy: 14‐year follow‐up of growth and school performance

Abstract: Sixty-five children born to women who all abused amphetamine during pregnancy have been followed prospectively since their birth in 1976-77. At the age of 14-15 years, information about growth and school achievement was collected from school records. For comparison of school achievements the means of schoolmates were used, and for growth a group of Stockholm children born in the same year. By the age of 14 years only 14 children (22%) had stayed with their biological mothers for the whole period since birth. In the eighth grade, 10 (15%) were one grade lower than indicated by their biological age. The norm for Sweden is less than 5 %. The means of the points in mathematics, Swedish language and sports were statistically below those of their classmates. At the age of 10 years the girls were significantly shorter and lighter than their peers born in 1976. At the age of 14 years the boys were statistically taller and heavier than their peers. It can be concluded that maternal amphetamine abuse during pregnancy will influence children at least up to the age of 14-15 years even though many of them have been living in foster homes since a young age.

Latent and potential coeliac disease

Abstract: Under the umbrella of coeliac disease (CD), or gluten-sensitive enteropathy, the concepts of silent, latent and potential CD have recently been introduced. While silent CD is marked by severe damage to the jejunal mucosa in the absence of clinical symptoms, both latent and potential CD are characterized by jejunal mucosa that would be reported as normal by most clinical pathologists in an individual on a gluten-containing diet. As opposed to potential coeliac patients, latent subjects sometimes in their life have had a flat jejunal biopsy which recovered on a gluten-free diet. Latent coeliac patients are often symptomatic; neither high titres of gliadin antibodies nor mucosal changes (including raised intraepithelial lymphocyte counts) are obligate features of latent CD, although the presence of elevated endomysial antibodies is probably the best predictor of progression towards villous atrophy. The term potential CD has been proposed for those subjects who do not have, and have never had, a jejunal biopsy consistent with overt CD, and yet have immunological abnormalities similar to those found in coeliac patients. Good markers of potential CD include the presence of serum endomysial antibodies, a high count of intraepithelial lymphocytes and subtle pathological alteration such as increased density of intraepithelial lymphocytes expressing gamma delta T cell receptor, signs of activated mucosal cell-mediated immunity, coeliac-like intestinal antibody pattern, and positive rectal gluten challenge.

Oral sweet solution reduces pain‐related behaviour in preterm infants

Abstract: To evaluate the effectiveness of oral sucrose in the prevention of pain-induced crying in preterm infants, a sample of 28 healthy neonates (15M, 13F ; gestational age at procedure less than 37 weeks) who were having routine blood drawn by arm venipuncture was studied. Infants were randomly allocated to receive by mouth, using a syringe, 2 ml of one of three solutions : spring water (group W) and sucrose 12 and 24% w/v (groups S12 and S24, respectively), all in water vehicle. After 2 min, while awake, arm venipuncture was performed and duration of crying was measured. The time spent crying was reduced in the group treated with the sweetest solution (S24, n = 8, mean = 19.1 s). No difference was observed between the S12 group (n = 8, mean = 63.1 s) and W group (n = 12, mean = 72.9s). Physiological measurements were recorded at different time points to evaluate excessive basal and procedural distress.

Early 99mTc dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first-time urinary tract infection.

Abstract: During a 2 year period, 175 children below 6 years of age (median 0.4 year) with non-obstructive symptomatic urinary tract infection were studied by 99mTc dimercaptosuccinic acid (DMSA) scintigraphy. DMSA scintigraphy was performed at a median of 10 days after the start of treatment and was abnormal in 73 children (42%), equivocal in 29 (16%) and normal in 73 (42%). Reflux was seen in 27% of all children and in 38% of the renal units that were abnormal at DMSA scintigraphy. A decreasing frequency of abnormalities at DMSA scintigraphy was seen within the first 14 days after the start of treatment. C-reactive protein and grade of reflux correlated significantly with abnormal DMSA studies. To demonstrate renal involvement in acute urinary tract infection, DMSA scintigraphy should be performed within days after the start of treatment. It is noteworthy that reflux was seen in less than half of renal units with abnormal DMSA scintigraphy.

Non‐malignant complications of coeliac disease

Abstract: Patients with coeliac disease are at increased risk of developing complications which increase morbidity and mortality. Emphasis on malignant complications has often overshadowed the non-malignant risks, which have received relatively little attention, although some of these can be very troublesome and even life-threatening. This article points out that a large population of unidentified or neglected coeliac patients is at potential risk. The challenge is to identify this group by case-finding or screening programmes in selected populations, so that they can be offered a gluten-free diet and other treatments which will not only improve general health but may also prevent or reduce the development of health problems. The non-malignant risks are outlined and bone and neuropsychiatric disturbances considered in more detail because of recent developments in these areas.

Relation between gliadin structure and coeliac toxicity

Abstract: Gliadin, the alcohol-soluble protein fraction of wheat, contains the factor toxic for coeliac patients. The numerous components of gliadin can be classified according to their primary structure into omega 5-, omega 1,2-, alpha- and gamma-type. Both omega-types have almost entirely repetitive amino acid sequences consisting of glutamine, proline and phenylalanine. alpha- and gamma-type gliadins contain four and five different domains, respectively, and are homologous within the domains III and V. Unique for each alpha- and gamma-type is domain I, which consists mostly of repetitive sequences rich in glutamine, proline and aromatic amino acids. Coeliac toxicity of gliadin is not destroyed by digestion with gastropancreatic enzymes. In vivo testing established the toxicity of alpha-type gliadins and in vitro testing of gliadin peptides revealed that domain I of alpha-type gliadins is involved in activating coeliac disease. The sequences -Pro-Ser-Gln-Gln- and -Gln-Gln-Gln-Pro- were demonstrated to be common for toxic gliadin peptides. Most of the in vivo and in vitro studies of synthetic peptides confirmed the importance of one or both of these sequences. Cultivated hexaploid, tetraploid and diploid wheat species do not differ significantly in potential toxic sequences of alpha-type gliadins.

Low back pain and its relationship to back strength and physical activity in children.

Abstract: Objective : The objective of the study was to determine the occurrence of low back pain and its relationship to back strength and physical activity in children. Methods and materials : The study included 53 boys and 43 girls aged 10 to 19 years from a group of 116 children who had undergone isometric strength testing 4 years previously. No intervention was performed. Each child was asked five questions concerning low back pain. A questionnaire to quantify participation in athletic activities and manual labor was used as the basis for calculation of each child's activity level. Isometric back flexor and extensor strength were measured with the same method used 4 years previously. Statistical analyses were performed with appropriate correction for confounding factors. Results : The frequency of low back pain and the relationship between low back pain and age, between low back pain and back strength, and between low back pain and physical activity were determined. There was a history of low back pain in 51%, and the frequency of low back pain in the past year was 35%. Eight percent of the children had been limited by low back pain, and 7% had seen a doctor for the pain. The first incident of low back pain occurred at a mean age of 12.3 years. The frequencies of a history of low back pain and of low back pain in the past year increased significantly with age (p = 0.02 and 0.01, respectively). Increased physical activity was significantly associated with a history of low back pain (p = 0.03), and increased back flexor strength was significantly associated with a history of low back pain and of low back pain in the past year (p = 0.03 and 0.008, respectively). The rate of change in back flexor strength over 4 years had a significantly positive association with the occurrence of low back pain in the past year (p = 0.008). Conclusions and relevance : Low back pain is common in children, and, in contrast to adults, low back pain in these children was more common with increased physical activity and stronger back flexors. We believe the main causes oflow back pain in children are musculotendinous strains and ligamentous sprains.

Infantile colic--less common than previously estimated?

Abstract: A two-part population-based study investigating the occurrence of infantile colic was undertaken, in which 92% of mothers with newborn healthy infants were reached. In the prospective part 152 mothers ("diary group") registered crying and fussing in their infants during 12 weeks. In the retrospective part 224 mothers ("interview group") were contacted by telephone at an infant age of 5-7 months. The colic occurrence was determined according to four different definitions; the rate varied from 3.3 to 17.1%. The classical "Wessel-type" colic was present in 9.3%. Colic defined as "crying seen as a problem by parent" was present in 12.1% of the "interview group", but in only 3.3% of the "diary group". Some earlier studies may have overestimated colic occurrence. Another possibility is an actual decline. The contributive part of preventive measures is discussed.

Female fertility, obstetric and gynaecological history in coeliac disease: a case control study.

Abstract: Objectives The purpose of this study was to investigate the incidence of infertility, abortions and perinatal mortality, age at menarche and menopause in coeliac disease. Method This was a case control study in which patients and controls, matched for age and sex, were sent questionnaires about their fertility profile and other obstetric and gynaecological problems. All 80 patients and 70 controls replied, but only 68 pairs could be matched for this study. Results The mean age of menarche in patients was significantly older (13.6 years) than in controls (12.7 years). The mean ages at menopause in patients and controls were 47.6 and 50.1 years, respectively. The mean number of children born to patients was significantly less at 1.9 (SD +/- 0.9) compared to 2.5 (SD +/- 1.2) in controls. Before diagnosis the mean number of children born to patients was 1.4 and 1.8 in controls. After diagnosis and treatment, patients had 0.5 children (SD +/- 0.9) compared to 0.7 in controls (SD +/- 1.2). It seems likely that the overall difference in fertility is due to relative infertility prior to diagnosis and its correction by a gluten-free diet. Significantly more conceptions amongst women with coeliac disease (15%) ended in miscarriage prior to diagnosis than amongst controls (6%). After diagnosis and treatment the rate of miscarriage was similar. There were 120 live babies and 7 stillbirths to patients compared with 161 live babies and 1 stillbirth to controls. Conclusions Patients with CD are subfertile and have an increased incidence of stillbirths and perinatal deaths.

Early diet of preterm infants and bone mineralization at age five years.

Abstract: Bone disease with significantly reduced bone mineralization is common in preterm infants, and associated with later linear growth stunting at 18 months of age. Dietary insufficiency of calcium and phosphorus is thought to be the principal aetiological factor. We studied 54 children at mean age 5 years who were born preterm and had participated in a prospective multicentre study of effects of early diet on later growth and development. Diets compared were banked donor breast milk and preterm formula fed as a supplement to mother's own milk. Increasing human milk intake was strongly positively associated with later bone mineral content. Children fed predominantly human milk had greater bone mineral content than children of similar size born at term. These data suggest that the early nutritional environment of the preterm infant could play an important role in determining later skeletal growth and mineralization.

α‐Lactalbumin‐enriched low‐protein infant formulas: a comparison to breast milk feeding

Abstract: Tryptophan (TRP) is the limiting amino acid in low-protein infant formulas. This is mainly due to lower alpha-lactalbumin (alpha LA) content in cow's milk whey as compared with human milk protein. To study the effect of alpha LA-enrichment on the TRP supply, cross-over studies were carried out in 20 healthy infants up to 3 months of age. In this study, two protein-reduced (1.3%) infant formulas (moderate TRP content of 1.88% and higher TRP content of 2.10%) were alternately fed over a 2 week period in two groups of infants. Serum TRP levels of the formula-fed infants with the higher TRP content did not differ significantly from an exclusively breastfed control group of 11 infants (10.5 +/- 4.8 versus 10.9 +/- 4.7 mg l-1, p = 0.841), whereas levels of the formula-fed infants with the moderate TRP content were significantly lower (7.4 +/- 3.9, p = 0.038). The supplementation of alpha LA resulting in a higher TRP supply to low-protein diets is a further step towards the production of infant formulas more closely adapted to human breast milk.

Waist percentiles: a simple test for atherogenic disease?

Abstract: Objective : To give standards for quantification of the magnitude of waist circumference in children. Methods : We calculated the percentiles of waist circumference by age and sex from a sample of 2858 subjects (1440 males and 1418 females, aged 6 14 years). Data were from a population survey of 15 000 school-children in Pescara, a town in Abruzzo. a region of Central Italy. Resuts : We reported the values of the calculated percentiles by age and sex and gave the smoothed percentile curves. Conclusions: Some recent studies in adults have indicated that measuring waist circumference seems to be the simplest way to estimate obesity and the risk of cardiovascular disease. In children, similar evidence is emerging. To date, no example of calculating standards has been published for quantitating the magnitude of waist circumference in children : therefore. our example of standard waist measurements could be used as a practical model for selecting subjects with a value of ≤ or > 2 SD from the mean. The metabolic status should then be checked by complementary laboratory examination.

Crying in separated and non‐separated newborns: sound spectrographic analysis

Abstract: During the first 1-2 h after birth crying occurs during separation from the mother and stops on reunion. In rats, such "separation distress calls" have distinct phonetic properties. We examined this early crying by sound spectrography in 29 healthy, full-term, vaginally delivered babies, randomly assigned either to be kept in a cot or to be placed in body contact with the mother during the 90 min following birth. The former babies cried almost 10 times more than the latter ones. The duration of the cry signal (the smallest element of a cry analysed by spectrography) in both groups was 0.8-09s; the melody contour was flat or slightly rising--falling with a fundamental frequency of around 500 hertz. The cry is provisionally characterized as a discomfort cry, elicited mainly by separation from the mother.

A comparison of pulmonary and femoral artery thermodilution cardiac indices in paediatric intensive care patients.

Abstract: We have assessed the agreement between pulmonary artery and femoral artery (COLD) thermodilution measurements of the cardiac index (Cl) in a group of paediatric intensive care patients. The COLD method gave consistently higher cardiac index values than the pulmonary artery catheter (PAC) ; however, the difference was small, with a mean value of 0.19 l/min -1 m -2 or 4.4% of the mean cardiac index. This difference is not clinically important and suggests that, under these circumstances, the COLD system provides an acceptable alternative to the pulmonary artery catheter for measurement of the cardiac index at the bedside.