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Aim: To investigate risk factors of adverse outcome in a cohort of very preterm children treated mainly with nasal continuous positive airway pressure (CPAP) during the neonatal course.Methods: In Denmark, preterm children are treated with nasal CPAP as a first approach to respiratory support. A national prospective study of all infants with a birthweight below 1000 g or a gestational age below 28 wk born in 1994-1995 was initiated to evaluate this approach. Of the 269 surviving children 164 (61%) were not treated with mechanical ventilation in the neonatal period. A follow-up of the children at 5 y of age was conducted. Data from the neonatal period and the 5-y follow-up were analysed.Results: In multivariate analyses including 250 children, a severely abnormal neonatal brain ultrasound scan was predictive of cerebral palsy (OR = 19.9, CI 95%: 6.1-64.8) and intellectual disability (OR = 6.2, CI 95%: 2.3-16.5). A high Clinical Risk Index for Babies (CRIB) score (OR = 2.4, CI 95%: 1.1-5.5) and chronic lung disease (OR = 2.8, CI 95%: 1.2-6.9) were predictive of intellectual disability. In univariate analyses mechanical ventilation was associated with cerebral palsy (OR=4.3, CI 95%: 1.7-10.8) and intellectual disability (OR = 2.2, CI 95%: 1.2-4.2), but the associations became insignificant in multivariate analyses including chronic lung disease and a severely abnormal ultrasound scan.Conclusion: The associations between neonatal risk factors and adverse outcome in our cohort were very similar to those found in other cohorts with another initial treatment of respiratory insufficiency. We found no significant adverse effects of mechanical ventilation beyond what could be explained by associations with chronic lung disease and IVH 3-4/PVL. [ABSTRACT FROM AUTHOR]

Background: The best method for prevention and control of congenital toxoplasma infection is uncertain. Prenatal screening is done in Austria and France, but the effect of treatment during pregnancy is not well documented. The aim of our study was to find out the maternofetal transmission rate and outcome in infants born to mothers who were not treated during pregnancy.Methods: We analysed 89873 eluates from phenylketonuria (PKU) cards from neonates and paired first-trimester serum samples from the mothers for specific IgG antibodies to Toxoplasma gondii. Children born to mothers who seroconverted during pregnancy were followed-up clinically and serologically to 12 months of age. In addition, 21144 PKU cards were analysed for toxoplasma-specific IgM antibodies during the last 12 months of the study.Findings: In 24989 (27.8%) cases both the PKU eluate and the first-trimester samples were IgG positive, which indicates previous maternal infection. 139 of the 64884 seronegative women acquired toxoplasma infection during pregnancy and gave birth to 141 infants (two sets of twins). 27 of these children were diagnosed with congenital toxoplasma infection. The transmission rate was 19.4% (95% CI 13.2-27.0). Clinical signs and symptoms were found in four (15%) of the 27 children. The additional analysis for toxoplasma-specific IgM antibodies from the PKU card identified seven of nine children with congenital toxoplasma infection. The false-positive rate for the IgM test was 0.19 per 1000, and no false-negatives were found.Interpretation: The risks of transmission of infection and of disease in the infant are low in an area with a low risk of toxoplasma infection. A neonatal screening programme based on detection of toxoplasma-specific IgM antibodies alone will identify between 70% and 80% of cases of congenital toxoplasmosis. [ABSTRACT FROM AUTHOR]

The aim was to study how, and to what degree, health-related quality of life (HRQOL), as assessed by children and their mothers, was related to overweight and obesity among children aged seven to nine years. Mother-child pairs of 149 non-overweight, 95 overweight and 16 obese children participated. We assessed HRQOL by the children's self-report and parent proxy report module of the PedsQL™ 4.0 Generic Core Scales. We found that non-overweight children scored HRQOL slightly higher than overweight ones but significantly higher than did obese children. The same pattern was seen for the mothers' proxy HRQOL score and mothers in general scored higher than the children did. The results indicate that mothers in general were not sufficiently aware of how overweight and obesity affect their children's HRQOL. The psychosocial dimension of HRQOL was the most important aspect for the children. Thus, there is a need for information of mothers/parents about the impact of overweight and obesity on children's HRQOL. Such intervention by health professionals may among other interventions help to prevent and reduce overweight and obesity among children and thus help to increase the children's HRQOL throughout their lives., (© The Author(s) 2014.)

This qualitative phenomenological study interviewed seven mothers to overweight children and six mothers to non-overweight children aged 7 to 9 years old about their views and experiences with preventing and managing overweight in their children. The essence was that the mothers felt responsible for their children's habits, including those leading to overweight. They also felt that competent and had the opportunity to take preventive measures against child overweight but they did not always have the energy to do so. Even resourceful mothers required support from nurses and health professionals. Our results contribute to better understanding how to approach, motivate and support mothers to draw on their own competencies to benefit their children's weight and health., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: We investigated mothers' and children's assessments of body weight and their expectations about perceived body size in relation to overweight of the children., Methods: We performed a case-control study of 111 cases of overweight children and 149 controls of non-overweight children (mean age 8.1 years) and their mothers. All were examined and interviewed about their assessment of body weight and their perception of a normal, attractive and acceptable body size., Results: Case children were less able than control children to correctly assess their own body weight (p < 0.001), as were mothers of overweight children (MOC) to assess their children's body weight (p < 0.001). The majority of mothers from both groups wished their children to have a normal body size, but 18% of MOC wished their children to have an overweight body size (p < 0.013). The majority of case children, control children and mothers found a normal body size for boys and girls to be the most attractive and socially acceptable, but more MOC found overweight among boys to be the most attractive (p = 0.006)., Conclusion: Overweight children and their mothers show increased uncertainty in the assessment of overweight and obesity, but the perception of a normal, attractive and socially acceptable body size is not distorted., (Copyright © 2011 S. Karger AG, Basel.)

Objective: We investigated mothers' possession and display of action competence to counteract or prevent overweight and eventual obesity in their children. Action competence is defined as a personal resource where the most important aspect is the individual's wish to take action and to believe in its benefit. It unfolds within the room for action as experienced by the individual due to action obstacles and action potentials., Methods: In a case-control study, mothers of 111 overweight children (MOC) were compared with mothers of 149 non-overweight children (MNC). They underwent a semistructured interview about action competence, lifestyle, and their 7- to 9-year-old children., Results: Compared to MNC, MOC considered it more important to change habits, both for themselves (p = 0.003) and their children (p < 0.001). MOC were more motivated to change habits (p < 0.001), assessed their action competence to be higher (p < 0.001), and felt to a greater extent that they supported their children to achieve an appropriate weight (p < 0.001) compared with MNC. No difference was found between MOC and MNC in the assessment of their own room for action and their children's room for action., Conclusion: Self-assessed room for action was not limited for either MOC or MNC, and MOC even assessed their action competence to be greater., (Copyright © 2011 S. Karger AG, Basel.)

The prevalence of hepatitis B virus (HBV) carriage in Denmark is unknown, but expected to be low (0.1%). This study aimed to evaluate the efficacy of selective antenatal screening for HBV infection and the epidemiology of HBV and hepatitis C virus (HCV) among pregnant women. 4098 women were included in the study. Blood tests were examined for hepatitis B surface antigen (HBsAg), anti-hepatitis B core antigen (HBc) and anti-HCV. Case records were studied to evaluate whether patients at risk for HBV infection had been tested. Among the 4098 women, 18 10.4%, 95% confidence interval (95% CI) 0.3-0.71 were HBsAg positive. All had a risk factor for HBV infection. Only 13 (72%) were identified as HBsAg positive in the selective screening programme. 115 women (2.8%, 95% CI 2.3-3.4) were anti-HBc positive only. 95 (83%) were at risk for HBV. Only 72 of these (63%) were tested for HBsAg. The screening programme in this area of Denmark did not pick up one-third of pregnant women at risk of HBV.

Unlabelled: Premature infants require large amounts of protein and energy to achieve normal growth. Feeding with human milk alone is therefore only regarded acceptable if the protein and energy content is adequate., Methods: 476 milk samples from 101 mothers delivering before the 32nd gestational week (mean gestational age, 28 weeks) were obtained on a weekly basis until 36 weeks of gestational age and analyzed for true protein, total carbohydrate, and fat content by infrared analysis. Fat measurements were validated with the Folch method. Milk was collected by complete expression with an electric pump into 24-hour pools., Results: The protein concentration decreased significantly with time (P = 0.00001). The carbohydrate, fat, and energy concentration was significantly lower in the first 2 weeks after delivery, after which they increased to a constant level. The macronutrient level in milk was not associated with gestational age (P = 0.3). The energy content of these milk samples was high, and feeding 200 mL/kg would provide sufficient energy until 36 weeks of gestational age for all infants, and 65% of the infants would receive > or =3g total protein/kg/day.

Energy, protein, and mineral requirements in premature infants are high, hence increasing the risk of poor growth and development of metabolic bone disease. This double-blind study included 127 consecutive premature infants with gestational age below 32 weeks. Both sick and healthy infants participated. Average duration of ventilator treatment: 2 days, CPAP treatment: 10 days (range, 0-50d). Infants were randomized to 3 groups from 1 week old to 37 weeks of gestational age and fed the following: a) human milk (their own mother's milk or banked milk) supplemented with phosphate, b) human milk fortified with protein, calcium, and phosphate, or c) unsupplemented mother's milk or preterm formula. Infants randomized to preterm formula were fed formula only if their own mother's milk was not available, hence there were 2 subgroups of infants fed either unsupplemented human milk or preterm formula. Volume of intake was 191+/-14mL/kg/d (mean +/- SD); linear growth was measured weekly by knemometry; head circumference was measured weekly; and growth rate was calculated by linear regression for each infant. Bone mineralization and body composition were measured by DEXA-scan (Hologic 1000/W) at term. There was a tendency toward slower growth and less bone mineral content in infants fed unsupplemented human milk but, surprisingly, the difference was small and not significant.

Functional magnetic resonance imaging (fMRI) in young children may provide information about the development of the visual cortex, and may have predictive value for later visual performance. The purpose of this study was to evaluate the usefulness of fMRI for examining cerebral processing of vision in very young infants and in infants with brain damage. We examined 15 preterm infants, 12 children suspected of having a cerebral visual impairment and 10 children with a normal visual system, all of whom were either spontaneously asleep or sedated with chloral hydrate. Cortical response to stroboscopic light stimulation could be demonstrated in all technically acceptable data sets from children with a post-menstrual age (PMA) of > 41 weeks, but not in younger infants. Children < 60 weeks PMA showed either a blood oxygenation level-dependent (BOLD) signal increase or decrease, while all older children showed a signal decrease. The activated cortical volumes showed a linear relation to age for healthy children younger than 90 weeks PMA, but were small in children with visual impairment. In two children with unilateral damage to the optic radiations, activation was strongly asymmetrical with greatest activation on the healthy side. In future prospective studies, results from the period from birth to six months of age should be interpreted with caution, as inter-individual variation of cortical development may be confused with functional deficit.

Premature infants are at risk of developing metabolic bone disease mainly because of low calcium and phosphorus intake. We have examined the effect of different mineral supplements on bone mineral content at term in 127 premature infants with gestational age <32 wk in a double-blinded randomized trial. We used either phosphate supplementation of human milk as recommended by the European Society of Pediatric Gastroenterology and Nutrition or fortified supplementation with protein, calcium, and phosphorus or preterm formula as recommended by the American Academy of Pediatrics. The intervention period was from 1 week old until 36 wk of gestational age, and the infants were fed approximately 200 mL x kg(-1) x d(-1). Bone mineral content was measured at term by dual-energy x-ray absorptiometry scan. Surprisingly, neither phosphate, fortifier, nor preterm formula supplementation had any significant effect on bone mineral content at term compared with infants fed their own mother's milk only. There was a tendency to higher total bone mineral content in infants fed preterm formula compared with infants fed their own mother's milk only (p = 0.05), but when the bone mineral content was corrected for the size of the infant, there was no difference (p = 0.68). Infants fed preterm formula had a significantly higher weight at term compared with infants fed their own mother's milk only (p = 0.02), but did not differ significantly in length or head circumference. In a regression analysis, the amount of supplemented phosphorus was significantly associated with weight at term (p = 0.008). We conclude that when feeding 200 mL x kg(-1) x d(-1), mineral supplementation of human milk or use of preterm formula does not significantly improve bone mineralization outcome at term.

The purpose of this study was to determine whether visual stimulation in sleeping infants and young children can be examined by functional magnetic resonance imaging. We studied 17 children, aged 3 d to 48 mo, and three healthy adults. Visual stimulation was performed with 8-Hz flickering light through the sleeping childs' closed eyelids. Functional magnetic resonance imaging was performed with a gradient echoplanar sequence in a l.5-T magnetic resonance scanner. Six subjects were excluded because of movement artifacts; the youngest infant showed no response. In 10 children, we could demonstrate areas of signal decrease during visual stimulation in the occipital cortex (mean decrease 2.21%), contrary to the signal increase observed in the adult controls (mean increase 2.82%). This decrease may be due to a higher proportional increase in oxygen extraction compared with increase in cerebral blood flow during activation. The different response patterns in young children and adults can reflect developmental or behavioral differences. Localization of the activation seemed to be age-dependent. In the older children and the adults, it encompassed the whole length of the calcarine sulcus, whereas it was restricted to the anterior and medial part of the calcarine sulcus in the younger infants. This may reflect a different functional organization of the young child's visual cortex or the on-going retinal development.

To investigate the metabolic consequences of germinal matrix hemorrhage (GMH) we used volume-selective 1H magnetic resonance spectroscopy in the striatal region in 12 preterm infants with predominantly small GMH. Both sides of the brain were investigated twice. Metabolite indices were calculated as the metabolite signal, recorded with TR = 1.6 s and TE = 272 ms, divided by the fully relaxed water signal corrected for transverse relaxation time constant (T2) decay. At the first investigation, when the infants were 32.5 +/- 2.0 (mean +/- SD) wk postmenstrual age, the hemorrhage was unilateral or markedly asymmetrical in size in 10 of 12 infants. The lactate index was higher (p < 0.01) and the phosphocreatine + creatine (Cr) (p < 0.05) and N-acetyl-L-aspartate (NAA) (p < 0.05) indices lower in the side with the larger hemorrhage. At the second investigation, 54.1 +/- 2.7 wk postmenstrual age, no sign of a previous GMH could be seen on magnetic resonance imaging in three of 10 infants. Lactate could be detected in two of 10 infants only, and the Cr and NAA indices did not differ between sides. However, the choline index was significantly higher in the side with the larger hemorrhage (p < 0.01). We conclude that GMH is initially followed by lactate accumulation and possibly a delay in maturation as indicated by the transiently low Cr and NAA indices. Moreover, an increased choline index at the corrected age of 3 mo indicates a more persistent metabolic change after small GMH.

Purpose: The purpose was to obtain normal values of the apparent diffusion coefficient (ADC) in the infant brain and to compare ADC maps with T1- and T2-weighted images., Method: Diffusion was measured in nine infants with an ECG-gated SE sequence compensated for first-order motion. One axial slice at the basal ganglia level was investigated with the diffusion-encoding gradients in the slice-selection direction., Results: On ADC maps, the corpus callosum and the optic radiations appeared dark before the onset of myelination, and the crus posterior of the internal capsule could be visualized before it appeared on T1- or T2-weighted images. In gray and white matter, the mean ADC ranged from 0.95 x 10(-9) to 1.76 x 10(-9) m2/s. In the frontal and occipital white matter, in the genu corporis callosi, and in the lentiform nucleus, the ADC decreased with increasing age. The cortex/white matter ratio of the ADC increased with age and approached 1 at the age of 30 weeks., Conclusion: ADC maps add information to the T1 and T2 images about the size and course of unmyelinated as well as myelinated tracts in the immature brain.

Twenty-eight infants with postmenstrual ages (PMA) in the range of 32-80 weeks were investigated. Twenty were newborn; among these the observed birth weight divided by the expected weight ranged from 0.31 to 1.1. Axial magnetic resonance images were recorded with a triple spin-echo sequence and the volumes were determined by encircling each structure of interest on every slice. Segmentation into grey matter, white matter and CSF was done by semi-automatic discriminant analysis. Growth charts for the cerebrum, cerebellum, corpora striata, thalami, ventricles, and grey and white matter are provided for infants with appropriate birth weight. The striatal (P = 0.02) and thalamic (P < 0.001) percentage of the hemispheric volume decreased with age, whereas the ratio of grey matter to white matter (G/W-ratio) increased (P = 0.01). In the neonatal patients, brain volumes were independently associated with both PMA and the degree of growth retardation. It was calculated that the hemispheric volume was reduced by from 16% to 23% if the total bodyweight was reduced by 40%. The G/W-ratio was found to be independently associated with the PMA (P < 0.05) and the degree of IUGR (P < 0.1) suggesting that fetal growth retardation reduces grey matter volume more than white matter.

During the 7 year period 1985 to 1991, 170 infants born in Hvidovre Hospital, Denmark, with birthweight < or = 1500 g and gestational age < or = 32 completed weeks survived at least 8 weeks or more and had eye examinations carried out. Forty-five infants had ophthalmoscopic evidence of retinopathy of prematurity (ROP). Eighteen developed blindness or severely reduced vision and 6 developed unilateral blindness. In 21 the ROP changes regressed. Eight infants eventually developed severe myopia. The 45 infants with ROP were compared with the 125 without ROP. There was no difference in birth weight, gender, or mode of delivery. Significant difference was found in gestational age, asphyxia, intensive treatment and complications. Particularly infants with ROP born with gestational age 27 to 29 weeks needed prolonged and more intensive treatment than infants without ROP. Infants with ROP had more frequently long term sequels from the central nervous system than infants without ROP.

The present study aimed to provide normative data for nasal airway resistance in the newborn. Anterior rhinomanometry was performed on 17 full term Caucasian infants aged 1 to 4 days, birthweight 3100 to 4150 g. No sedation or decongestion was performed. Average unilateral nasal resistance was 4.86 kPa/l/s (SD = 2.41) at a pressure threshold of 75 Pa. Average nasal resistance calculated from the right and left side recordings was 2.14 kPa/l/s (SD = 0.77). This corresponds to 21.8 cm H2O/l/s (SD = 7.9). The nasal resistance of the newborn thus is approximately 10 times that of the adult.

Thirty-seven children treated with netilmicin during the neonatal period were seen at follow-up at the age of 2-4 years to investigate for possible vestibular damage caused by netilmicin therapy. No definite vestibular damage could be found in these 37 patients, including three patients in whom greatly elevated serum concentrations of netilmicin had been measured. The present study confirms previous findings in adults showing a low ototoxicity of netilmicin.

200 newborns, gestational age between 27 and 43 weeks (mean 39 weeks) and a birth weight between 900 and 4600 g (mean 2600 g) were studied. 18 patients had severe infections, 20 topical infections, 11 had signs of infection but negative microbiological cultures, 26 had positive cultures but no clinical signs of infection, and 125 patients had no sign of infection at all. In the group without infection (125 patients), the micromethod erythrocyte sedimentation rate (MESR) raised slowly from 2 mm/h at birth (95% upper limit 8 mm/h) to 4 mm/h 8 days after delivery. The MESR of the patients with respiratory distress, asphyxia, intubated children and patients with umbilical catheter, who had no infection, did not differ from other patients in this group. In patients with focal and general infections, rapidly rising MESR within wide limits was observed. Thus, in the individual newborn a high MESR supports the diagnosis of severe infection, whereas a low MESR does not exclude this diagnosis.

The quantitative distribution of the lymphocyte subpopulations (B, T and null) and the serum concentrations of Human Chorionic Somatomammotropin (HCS), immunoglobulins IgG, IgM and IgA, complement component C4 and C1 inactivator, were estimated in venous blood samples from 32 women at various stages of pregnancy and compared with a control series of 7 non-pregnant normal women. A significant decline in the B cell percentage during pregnancy was seen. The fall in the percentage of the B lymphocytes was found to be concomitant with the rise in HCS concentration. No significant changes in the other parameters studied were present.

38 newborn infants, 28 males and 10 females, were treated with netilmicin in doses 6-7 mg/kg/day for suspected or verified infections. 19 patients were mature (mean birth weight 3169 g) and 19 were premature (mean birth weight 1864 g). 32 had moderate or severe underlying diseases. 37 babies survived, 33 were cured or improved markedly and in 4 the results were indeterminate. Pathogenic bacteria were demonstrated in 24 cases and were eliminated in 15. Only one baby died. He suffered from severe respiratory distress syndrome and Escherichia coli septicemia. No E. coli was isolated at autopsy. The mean netilmicin peak serum value was 7.7 micrograms/ml (range 1.0-30.0) and the mean trough concentration 2.1 micrograms/ml (range 0.0-9.2). No adverse effects were seen.