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Aim Treatment of neonatal seizures still relies primarily on phenobarbital, despite an estimated efficacy of less than 50% and concern over neurodegenerative side effects. The objective of this study was to evaluate the efficacy and safety of lidocaine as second-line treatment of neonatal seizures in infants following benzodiazepine treatment but without previous treatment with phenobarbital. Methods In a 10-year cohort, a retrospective chart review was conducted for all infants (gestational age ≥ 37 w, age ≤ 28 days) who had received lidocaine as second-line treatment of neonatal seizures prior to treatment with phenobarbital between January 2000 and June 2010. Infants were included if they had electroencephalographic seizures. Results Cessation of seizure activity was seen in 16 of 30 infants based on clinical and electroencephalographic features, and a probable response was seen in an additional 3 of 30 patients. Suspected adverse effects were seen in only one patient, who developed a transient bradycardia. Conclusion Lidocaine has a moderate efficacy as second-line therapy following benzodiazepines for treating neonatal seizures and is not frequently associated with cardiovascular adverse effects. Lidocaine should therefore be considered in the treatment of seizures in the neonatal period to a higher extent than is the case today. [ABSTRACT FROM AUTHOR]

Aim: To determine whether early nasal intermittent positive pressure ventilation (NIPPV), in comparison to early continuous positive airway pressure (CPAP), can reduce the need for intubation and mechanical ventilation in preterm neonates with suspected respiratory distress syndrome (RDS). Methods: In this stratified open-label randomized controlled trial, neonates (28–34 weeks gestation) with respiratory distress within 6 h of birth and Downe's score ≥ 4 were eligible. Subjects were randomly allocated to ‘early-NIPPV’ or ‘early-CPAP’ after stratifying for gestation (28–30 weeks, 31–34 weeks) and surfactant use. Primary outcome was failure of the allocated mode within 48 h. Results: Seventy-six neonates were enrolled (37 in ‘early-NIPPV’ and 39 in ‘early-CPAP’ groups). Failure rate was less with ‘early-NIPPV’ versus ‘early-CPAP’[13.5% vs. 35.9%, respectively, RR 0.38 (95% CI 0.15–0.89), p = 0.024]. Similarly, need for intubation and mechanical ventilation by 7 days (18.9% vs. 41%, p = 0.036) was less with NIPPV. Failure rate with NIPPV was less in the subgroups of subjects born at 28–30 weeks (p = 0.023) and who did not receive surfactant (p = 0.018). Conclusion: Among preterm infants with suspected RDS, early use of NIPPV reduces the need for intubation and mechanical ventilation compared to CPAP. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the diagnostic value of the skin-prick test and the atopy patch test in diagnosing basic food allergy in young children suffering from atopic eczema/dermatitis syndrome.Methods: 141 children, the majority under 2 y of age (mean 16 mo) with atopic eczema/dermatitis syndrome were investigated using skin-prick and atopy patch tests for milk, egg, wheat and rye. Open diagnostic elimination challenge was done since this has been reported to be a reliable method in young children.Results: A positive challenge response was found to milk in 63 (45%), egg in 78 (55%), wheat in 61 (43%) and rye in 61 (43%). Sensitivity/specificity of the atopy patch test was 60%/97% for milk, 71%/97% for egg, 90%/94% for wheat and 93%/90% for rye. For the skin-prick test the corresponding figures were 41%/99%, 60%/97%, 13%/98% and 15%/99%.Conclusion: Patch testing was found to be a more sensitive method than the skin-prick test in diagnosing food allergy in children with atopic eczema/dermatitis syndrome, especially in those under 2 y of age. Many children with a negative skin-prick test result have a positive patch test result, especially in the case of cereals. A diagnosis of food allergy should be confirmed by elimination and in the research setting also by challenge. [ABSTRACT FROM AUTHOR]

Unlabelled: This study investigated the prevalence of overweight [body mass index (BMI) > or = 25 kg m-2] in young adulthood among international adoptees. The prevalence of overweight among adoptees from various countries of origin was compared with that in a large group of non-adopted individuals. All 275,026 young men born in 1973-1977 and living in Sweden at 17 y of age were included. A record linkage was made between the Military Service Conscription Register and several population registers. Data on BMI at 18 y of age were obtained from military conscription examinations conducted in 1991-1995. BMI was missing for 12.7% of 2400 adoptees and 10.8% of 263,173 non-adoptees. Among 623 adoptees from Latin America 21.5% (95% confidence interval 18.3-24.7) were overweight, with a particularly high prevalence of overweight among the 266 adoptees from Chile (28.6%, 23.1-34.0). Among 502 adoptees from the Indian subcontinent 8.4% (5.9-10.8) were overweight and the prevalence of overweight was 8.8% (5.7-12.0) among 317 adoptees from India. Among 817 adoptees from the Far East 12.0% (9.8-14.2) were overweight and the prevalence of overweight was 10.9% (7.9-13.9) among 404 from South Korea. The corresponding figure was 14.1% (14.0-14.2) among the non-adopted individuals.Conclusion: These differences in prevalence of overweight between various groups of adoptees and between adopted and non-adopted subjects are remarkable and are probably due to diversity in genetic susceptibility to overweight. [ABSTRACT FROM AUTHOR]

Unlabelled: Early puberty is frequently observed in adopted children. This randomized trial treated 30 adopted children with early puberty and short stature with either gonadotropin-releasing hormone agonist (GnRHa) alone or in combination with growth hormone (GH) for 3 y. Before the start of treatment (T1) in the trial and at discontinuation (T2) the children and their parents underwent a psychological evaluation. At the start of treatment the children did not have increased levels of behavioural or emotional problems as assessed by the Child Behaviour Checklist (CBCL). During treatment the CBCL scores did not increase. Self-perception of the children appeared to be normal, and after 3 y a significantly higher score for acceptance by peers was observed. At T1, an overestimation of future height was present in 80% of the children and 17% of the parents. Lower family stress was observed at T1 and T2 compared with reference values. Intelligence quotient levels decreased significantly during treatment. The findings are discussed with reference to the reported levels of behavioural and emotional problems in adopted children and the psychosocial effects of precocious puberty.Conclusion: This psychological evaluation did not reveal any consistent abnormalities in adopted children with early puberty. Treatment with GnRHa with or without GH did not increase emotional and behavioural problems in adopted children, nor was their self-perception decreased. [ABSTRACT FROM AUTHOR]

A male newborn was admitted to our Unit because of early sepsis and shock. He required antimicrobial therapy and mechanical ventilation and initially did well, although he exhibited jaundice and cholestasis. During the second week he deteriorated, with radiological opacification of the right hemithorax and pleural effusion, and did poorly in spite of antibiotical therapy and drainage of the effusion. In the third week, the X-ray suggested some bowel loops in the right hemithorax. A right-sided diaphragmatic hernia was confirmed by a CT-scan, and surgery was performed with good outcome. The association of delayed-onset right-sided CDH following early sepsis and obstructive jaundice has not been published before, and illustrates a scarcely known form of presentation of this condition. [ABSTRACT FROM AUTHOR]