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Unlabelled: The diagnostic work-up of children seeking health care because of recurrent abdominal pain is a clinical challenge. Food hypersensitivity might be one of the aetiologies behind this symptom. Neither the understanding of possible immune mechanisms nor endoscopic or histological findings have yet contributed to reliable diagnostic tests.Conclusion: The possibility of adverse food reactions should be evaluated among other abnormalities behind recurrent abdominal pain in children. Still, the diagnosis of immunemediated food reactions depends on open or blinded food challenge. [ABSTRACT FROM AUTHOR]

Using an investigation protocol, the aim of this study was to determine the frequency of organic abnormalities in children with recurrent abdominal pain, as new diagnostic approaches may reveal a higher prevalence of organic disease in this group than has been found in most studies. Included in the study were 44 children (mean age 8.3 y; 2-15) with more than three bouts of abdominal pain severe enough to affect the daily activities of the child and lasting more than 3 mo. The investigation covered a detailed medical story, a physical examination, blood, urine and stool samples. The somatic investigation was completed by abdominal X-ray and ultrasound, lactose-breath-hydrogen test and 24-h pH monitoring in the lower oesophagus. A Child Behaviour Checklist was completed to assess psychosocial aspects of the illness. The blood, urine and stool samples were normal, and abdominal ultrasound did not give any results related to the symptoms. Constipation was diagnosed in 7 patients (16%); 9 patients (21%) had gastro-oesophageal reflux and oesophagitis was found in another 3 children. One child had nodular antral gastritis with colonization by Helicobacter pylori, and three children had pathological lactose-breath-hydrogen tests. Twenty-four children (55%) did not have any signs of organic disease. The total score for the CBCL was in the normal range in 89%. Conclusion: Our observations indicate a higher proportion of organic abnormalities in recurrent abdominal pain than has been found in most previously reported studies, though a multicausal approach seems important. [ABSTRACT FROM AUTHOR]

Background: Childhood antibiotic use has been associated with inflammatory bowel disease (IBD), although the potential contribution of infection frequency remains uncertain., Aims: To explore the association between early-life infections, antibiotics and IBD development., Methods: We used population-based data from ABIS (Sweden) and MoBa (Norway) cohorts following children from birth (1997-2009) until 2021. Prospectively collected questionnaires identified infection frequency (any, gastrointestinal and respiratory) and antibiotics (any, penicillin and non-penicillin) until age 3. IBD diagnosis required ≥ 2 records in national health registries. Cohort-specific hazard ratios (aHR), adjusted for parental education, smoking and IBD were estimated and pooled using a random-effects model. Antibiotic analyses were adjusted for infection frequency., Results: There were 103,046 children (11,872 ABIS and 91,174 MoBa), contributing to 1,663,898 person-years of follow-up, during which 395 were diagnosed with IBD. The frequency of any infection at 0 to < 1 and 1 to < 3 years showed a pooled aHR of 1.01 (95% confidence interval [CI] = 0.96-1.07) and 1.00 (95% CI = 0.99-1.01) per additional infection for IBD. Adjusting for infections, any versus no antibiotics in the first year was associated with IBD (pooled aHR = 1.33 [95% CI = 1.01-1.76]). The aHR for additional antibiotic course was 1.17 (95% CI = 0.96-1.44), driven by penicillin (per additional course, aHR = 1.28 [95% CI = 1.02-1.60]). Although antibiotics at 1 to < 3 years did not show an association with IBD or Crohn's disease, non-penicillin antibiotics were associated with ulcerative colitis (per additional course, aHR = 1.95 [95% CI = 1.38-2.75])., Conclusion: Early-life antibiotic use was, a significant risk factor for childhood and early adult-onset IBD, independent of infection frequency., (© 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)

Aim: We aimed to study the prevalence of hpyothermia among neonates, the association between admission temperature and neonatal mortality, and the impact of radiant warmers., Methods: In an observational prospective study, we included 1988 neonates born at Haydom Lutheran Hospital, Tanzania, and admitted to the neonatal unit from 1 January 2018 to 31 December 2022. We explored risk factors for hypothermia (<36.0°C, primary outcome) and newborn mortality by admission temperature (secondary outcome) with adjusted odds ratios (aOR) and 95% confidence intervals (CI) for birth weight and bag and mask ventilation., Results: Hypothermia was present in 47.0% (n = 935) at admission, 46.9% (n = 932) were normothermic or mildly hypothermic (36.0-37.5°C), and 6.1% (n = 121) hyperthermic. Of those admitted to the neonatal unit, 217 (10.9%) died. For every 1°C increase in temperature, neonatal mortality decreased by 31% (aOR 0.69, 95% CI 0.59-0.82). Admission temperature <34.5°C was strongly associated with mortality (aOR 3.56, 1.87-6.79). Mild hypothermia (36.0-36.5°C) was not associated with mortality (aOR 1.30, 0.72-2.37). Risk factors for hypothermia were bag and mask ventilation (aOR 2.53, 2.07-3.11) and low birth weight. The introduction of radiant warmers from 1 May 2022 was associated with a decrease in hypothermia (aOR 0.54, 0.41-0.72)., Conclusion: Hypothermia is prevalent even in tropical settings and maintaining normothermia after birth is critical and achievable for reducing neonatal mortality., (© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: Novel markers to reflect the intestinal damage in coeliac disease are needed. We studied the potential of faecal and serum neopterin, and faecal myeloperoxidase, human β-defensin-2, and lipocalin-2 in a case-control study., Methods: Data were collected from medical records and a biobank including newly diagnosed coeliac disease patients, potential coeliac disease patients and non-coeliac controls. Commercially available ELISA assays were used for measuring the biomarkers., Results: Altogether 19 patients with coeliac disease (median age 9.0 years), 8 with potential coeliac disease (4.0 years) and 18 controls (6.5 years) were included. The highest faecal neopterin levels were seen in potential coeliac disease, followed by controls and coeliac disease (median 513 vs. 372 vs. 255 nmol/L, respectively, p = 0.016). Also, serum neopterin was highest in the potential coeliac disease group (9.8 vs. 5.5 vs. 5.9 nmol/L, p = 0.022). After age adjustment and robust variance estimation, only differences in serum neopterin remained significant. Other markers did not differ between the groups. None of the markers were significantly associated with serum transglutaminase-2 antibody levels., Conclusion: Differences in neopterin levels amongst patients with potential coeliac disease, coeliac disease, and controls suggest that neopterin might serve as an early disease marker., (© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: We want to verify the correlation between the increasing use of novel nicotine-containing products (NNCPs) and non-nicotine delivery products (NNDPs) among young individuals and the escalating negative health consequences, necessitating their prohibition., Methods: We performed a comprehensive analysis of the most relevant literature about the utilisation of NNCPs and NNDPs among young individuals and their health effects., Results: Despite being initially seen as less harmful alternatives, for smokers aiming to quit, these products have become more popular due to misleading marketing claims. Teenagers using NNCPs and NNDPs, despite having no smoking history, are more likely to transition to tobacco smoking. Consistent use can lead to health issues like pulmonary damage, asthma, and cardiovascular and ocular problems., Conclusion: The EAP and the ECPCP endorse the WHO's appeal to outlaw these hazardous products. They urge European governments to forbid the sale of NNCPs and NNDPs to children and adolescents in order to safeguard their well-being. They also propose specific recommendations (box 4) to support this cause., (© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Background: In coeliac disease and environmental enteropathy, dietary gluten and enteric infections cause reversible inflammation and morphological changes to the small intestinal mucosa that can be detected in biopsy samples obtained by endoscopy. However, there is a clear need for non-invasive biomarkers. Constant shedding of mucosal material into the bowel lumen and faeces, together with easy availability of stool, makes it an interesting sample matrix., Aims: To conduct a systematic literature search and summarize the existing evidence for host mucosa-derived faecal biomarkers in evaluating small intestinal damage., Methods: We searched for studies on PubMed (MEDLINE) until 1 March 2024., Results: We identified 494 studies and included 35 original case-control and cohort studies. These assessed host mucosal transcripts and 14 other markers aiming specifically to reflect inflammation and cell-mediated, innate and gluten-induced immune responses. In coeliac disease, faecal calprotectin and anti-gliadin, tissue transglutaminase, endomysium and deamidated gliadin peptide antibodies were the most studied but with inconsistent results. Single studies reported positive findings about microRNA transcripts, β-defensin-2, lipocalin-2, zonulin-related proteins and angiotensin-converting enzyme. In environmental enteropathy, a non-significant association was reported between calprotectin and urine lactulose/mannitol ratio; there were conflicting results for neopterin, myeloperoxidase and host transcripts. Single studies reported a positive association for lactoferrin, and a negative association for regenerating islet-derived protein 1. Studies comparing faecal markers against small intestinal biopsy findings were not identified in environmental enteropathy., Conclusions: Further studies are needed to determine reliable faecal markers as a proxy for small intestinal mucosal damage., (© 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)

Aim: To examine possible geographical and temporal differences in the incidence of childhood-onset inflammatory bowel disease (IBD) in Norway, motivated by previous research indicating relevant environmental factors explaining changing epidemiology., Methods: We analysed data from children born in Norway from 2004 to 2012 (n = 541 036) in a registry-based nationwide study. After validating registry diagnoses against medical records, we defined IBD as ≥2 entries of International Classification of Diseases, 10th revision (ICD-10) codes K50, K51 and K52.3 in the Norwegian Patient registry. We estimated hazard ratios (HR) for IBD across four geographical regions with a south-to-north gradient and the incidence by period of birth., Results: By the end of follow-up on 31 December 2020, 799 IBD diagnoses were identified (Crohn's disease: n = 465; ulcerative colitis, n = 293, IBD: unclassified, n = 41). Compared to children in the southernmost region, there was almost a two-fold HR for IBD in children in the most Northern region (HR = 1.94, 95% Cl = 1.47-2.57; Mid region: HR = 1.68, 95% CI = 1.29-2.19, p trend  <0.001). These estimates remained largely unchanged after adjustment for potential confounding factors. The cohorts born in 2004-2006 and 2010-2012 had comparable cumulative incidences, with a slightly higher incidence for those born in 2007-2009., Conclusion: We observed an increase in the risk of IBD by increasing latitude which may suggest that environmental factors influence the development of IBD, although non-causal explanations cannot be ruled out., (© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: Respiratory tract infections (RTIs) are major contributors to childhood antibiotic use. We aimed to investigate geographical and temporal trends in the prescription of antibiotics and consultations for RTIs in children <18 years living in Norway from 2010 to 2017., Methods: In a nationwide observational study, we analysed antibiotic prescriptions from the Norwegian Prescription Database and reimbursed contacts from primary care physicians. We limited the study to airway antibiotics and diagnostic codes indicating RTIs., Results: Antibiotic prescriptions due to an RTI varied from 75 to 134 per 1000 consultation due to RTI across counties in Norway (relative risk 1.79, 95% CI 1.68-1.90 for highest compared to lowest). The use of health care varied from 414 to 585 consultations for RTI per 1000 inhabitant/year (relative risk 1.43, 95% CI 1.41-1.44 for highest compared to lowest). From 2010 to 2017, we observed a 21% reduction in antibiotic prescriptions per RTI consultation and of 6% for the number of consultations for an RTI. At the county level, the use of health care was positively associated with the proportion of RTIs that resulted in antibiotic prescription., Conclusion: We found a reduction in doctors' antibiotic prescription and the use of health care for RTIs, and a variation across counties., (© 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: To systematically review the evidence on Covid-19 infection risk, severity and vaccination uptake among children and adolescents by socioeconomic status., Methods: We conducted a systematic literature review, using the PubMed database. We searched for articles published from January 2020 to January 2022 using "MeSH" words and titles. The key terms were "COVID", "social status", "socioeconomic factor" and "children". We also searched secondary sources such as published reports and other databases., Results: The search identified 15 relevant articles and reports. This review shows that children of lower socioeconomic status have a higher risk of COVID-19 infection and a higher risk of being hospitalised. Mortality in a global setting was also higher in children with low socioeconomic status, though not observed in high-resourced countries. These children are also less likely to be vaccinated against the SARS-CoV-2 virus., Conclusions: The higher risk of COVID-19 infection and hospitalisation and lower vaccination coverage in children and adolescents from lower socioeconomic backgrounds demonstrate health disparities also in young age. These disparities should inform health authorities in planning for future pandemics., (© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: To examine the clinical follow up of paediatric coeliac disease and the rate of loss of follow up during childhood, for which data are scarce., Methods: In a cohort of coeliac children diagnosed in 2013-2018 in Gothenburg, Sweden, we retrospectively explored the follow-up practice of paediatric coeliac disease until June 2021. We used medical records from hospital-based paediatric gastroenterology and general paediatric outpatient clinics, laboratory records, and questionnaires. Loss of follow up was defined no coeliac disease-related follow up or tissue transglutaminase test over the past 2 years of study enrolment., Results: We included 162 children (58% girls) aged 7.8-18.2 years (average 12.7). Most participants (76%) were followed at general paediatric outpatient clinics rather than hospital-based clinics. After 2.3-8.8 (average 5.3) years since diagnosis, 23 patients (14%; 95% confidence interval, 9%-21%) had been lost to follow up. Patients with loss of follow up were more often boys (61% versus 39%, p = 0.08), with a somewhat longer average disease duration of 5.8 versus 5.2 years (p = 0.11). There were no between-group differences in socio-economic characteristics and patient-reported experience measures of coeliac disease care., Conclusion: One in seven coeliac patients may experience loss of follow up during childhood., (© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Aim: There is weak evidence that proton pump inhibitors (PPIs) alleviate non-specific complaints often attributed to gastroesophageal reflux in infancy and international guidelines do not recommend their use. We studied PPIs dispensed for infants in three Nordic countries., Methods: This was an observational population-based study of infants living in Norway, Sweden and Denmark in 2007-2020. We used nationwide pharmaceutical registers to study dispensed PPIs. The data provided a total of 3.3 million observed years on about 240 000 annual births., Results: The overall use of PPIs in infancy showed a marked increase in all three countries from 2007 to 2020. In 2020, PPI dispensing was 46.4, 23.4 and 18.9 per 1000 per year in infants aged 0-11 months in Denmark, Norway and Sweden. These were increases of 357%, 585% and 556% respectively. Although the rate was highest in Denmark, it had decreased by 42% in the last 3 years of the study., Conclusion: Despite international recommendations against routine PPI prescribing in infancy, dispensed PPIs increased more than fourfold on average in three Nordic countries from 2007 to 2020. The reason for this notable increase could not be established from the data, but the large variations over time, and between the countries, probably indicated unwarranted use., (© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Background: Coeliac disease is an immune-mediated intestinal disease characterised by lifelong intolerance to dietary gluten in genetically predisposed individuals. Microbial factors including infections or bacterial microbiota have long been suspected to be involved in the aetiology, but the scientific literature on the topic is scattered and heterogeneous., Aims: To review human observational studies on microbes and coeliac disease METHODS: We identified 135 publications judged relevant. Most studies were cross-sectional, and prone to reverse causation and other biases. Only a few were prospective. Cohort studies and longitudinal studies that have sampled biological specimens before disease onset are emphasised in the review., Results: Infections during early childhood were associated with an increased risk of subsequent coeliac disease in nine studies , whereas maternal infections during pregnancy did not show a clear association. For the most frequently studied microbial factors, some evidence for an association was found, including Helicobacter pylori (four out of 16 studies), adenovirus (two out of nine studies) and enterovirus (two out of six studies). Rotavirus infections have been associated with disease development, and rotavirus vaccination may reduce the risk. Among the many studies of gut microbiota, most were cross-sectional and, therefore, potentially influenced by reverse causation. Only two smaller prospective case-control studies with sampling before disease onset were identified; they reported inconsistent findings regarding the faecal microbiome., Conclusions: Several microbes are potentially linked to coeliac disease. As microbial factors are amenable to interventions, larger prospective studies are still warranted., (© 2020 John Wiley & Sons Ltd.)

Aim: To study whether a simple targeted intervention could reduce unwarranted antibiotic treatment in near-term and term neonates with suspected, but not confirmed early-onset sepsis., Methods: A quality improvement initiative in three Norwegian neonatal intensive care units. The intervention included an inter-hospital clinical practice guideline for discontinuing antibiotics after 36-48 hours if sepsis was no longer suspected and blood cultures were negative in neonates ≥ 34+0 weeks of gestation. Two units used procalcitonin in decision-making. We compared data 12-14 months before and after guideline implementation. The results are presented as median with interquartile ranges., Results: A total of 284 infants (2.5% of all births ≥ 34+0 weeks of gestation) received antibiotics before and 195 (1.8%) after guideline implementation (P = .0018). The two units that used procalcitonin discontinued antibiotics earlier after guideline implementation than the unit without procalcitonin. Neonates not diagnosed with sepsis were treated 49 (31-84) hours before and 48 (36-72) hours after guideline implementation (P = .68). In all infants, including those diagnosed with sepsis, antibiotic treatment duration was reduced from 108 (60-144) to 96 (48-120) hours (P = .013)., Conclusion: Antibiotic treatment duration for suspected, but not confirmed early-onset sepsis did not change. However, treatment duration for all infants and the proportion of infants commenced on antibiotics were reduced., (© 2020 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: Using routine blood sampling in a gastroenteritis diagnostic workup is debatable. This study examined the relationship between the severity of acute gastroenteritis and blood test abnormalities., Methods: We prospectively enrolled children under five years of age referred for outpatient or inpatient management for gastroenteritis from February 2014 to April 2016. The four study hospitals cared for 30% of Norwegian children. The severity of gastroenteritis was assessed using Vesikari scores. Blood samples were analysed at each hospital., Results: The 659 children had a median age of 19 months. The rotavirus was found in 314/514 children with stool samples (61%). Severe gastroenteritis, indicated by a Vesikari score of ≥11, was found in 392/549 (71%) with completed scores, but only 40 of 649 (6%) assessed for dehydration were more than 5% dehydrated. None had sodium <130 mmol/L. Glucose of 3.0-3.3 mmol/L was detected in 52/578 (9%) and <3.0 mmol/L in 33/578 (6%). Hypoglycaemia, elevated urea, low bicarbonate and negative base excess were associated with disease severity. The duration of vomiting and the rotavirus infection were associated with hypoglycaemia. Elevated urea, low bicarbonate and negative base excess had high specificities, but low sensitivities., Conclusion: Hypoglycaemia was common in acute gastroenteritis, but major electrolyte disturbances were infrequent., (©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Problem: Previous studies have suggested that immune perturbations during pregnancy can affect offspring type 1 diabetes (T1D) risk. We aimed to identify immunological markers that could predict offspring T1D or that were linked to T1D risk factors., Method of Study: We quantified selected circulating immunological markers in mid-pregnancy (interleukin [IL]-1β, IL-1ra, IL-2Rα, IL-2, -4, -5, -6, -10, -12p70, 13, -17A, GM-CSF, IFN-γ, CXCL10, CCL 2, CCL3, CCL4, TNF) and cord blood plasma (neopterin and kynurenine/tryptophan ratio) in a case-control study with 175 mother/child T1D cases (median age 5.8, range 0.7-13.0 years) and 552 controls., Results: Pre-pregnancy obesity was positively associated with CCL4, CXCL10, kynurenine/tryptophan ratio and neopterin (P < .01). The established T1D SNPs rs1159465 (near IL2RA) and rs75352297 (near CCR2 and CCR3) were positively associated with IL-2Rα and CCL4, respectively (P < .01). There was a borderline association of CCL4 and offspring T1D risk, independent of maternal obesity and genotype. When grouping the immunological markers, there was a borderline association (P = .05) with M1 phenotype and no association between M2-, Th1-, Th2- or Th17 phenotypes and offspring T1D risk., Conclusion: Increased mid-pregnancy CCL4 levels showed borderline associations with increased offspring T1D risk, which may indicate a link between environmental factors in pregnancy and offspring T1D risk., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Unlabelled: Coeliac disease is triggered by an interplay of environmental and genetic factors and is one of the most prevalent autoimmune diseases in children, occurring in about 1% of Europeans. Over the last few decades, there has been a growing interest in the role of the perinatal environment in coeliac disease and this review discusses the growing body of literature on coeliac disease and perinatal risk factors., Conclusion: There is still only circumstantial evidence that the perinatal environment influences coeliac disease development. Large-scale cohort studies and emerging scientific concepts, such as epigenetics, may help us establish the role of these environmental factors., (©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: This study aimed to evaluate the reproducibility of macronutrient measurements of domestic pooled human milk from mothers with preterm infants and to see how the results affected human milk fortifications., Methods: We asked 28 new mothers to express their breast milk for 24 h on two consecutive days and repeat the process at weekly intervals. The samples were analysed using mid-infrared technology to calculate the differences between the milk collected on two consecutive days for reproducibility and the total protein supply with standard fortification., Results: There was a significant linear correlation between the two consecutive days with regard to protein (r = 0.94, p < 0.001), lipids (r = 0.86, p < 0.001), lactose (r = 0.91, p < 0.001) and 24-h volume (r = 0.96, p < 0.001). The percentage of the samples that would provide a protein supply of 3.5-4.5 g/kg/d with a fortification of 0.6 and 1.2 g protein/100 mL at a volume of 170 mL/kg were 28% and 41%, respectively., Conclusion: The domestic pooling of 24-h expressed human milk for macronutrient analysis was a simple and reliable way of obtaining representative data. Standard fortification implies there is a risk of under- and over-nutrition, and individual fortification may improve the nutrition of preterm infants., (©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: To explore the prevalence of symptoms suggestive of gastro-oesophageal reflux disease (GERD) in asthmatics and controls, and to control for the possible effect of overweight., Methods: The prevalence of GERD symptoms was assessed using a questionnaire about reflux symptoms in children with asthma (n=872, mean age 10.4 y, 65% males) compared to non-asthmatic controls (n=264, mean age 10.8 y, 48% males), and a symptom score was calculated. The association between GERD symptoms and overweight (age-adjusted BMI > 25) was assessed independently., Results: A positive reflux symptom score was found in 19.7% of the asthmatics compared to 8.5% of the non-asthmatic control group (odds ratio (OR) 2.6, 95% CI 1.7-4.2). Overweight children reported GERD symptoms more frequently than children with normal weight (OR 1.8, 95% CI 1.2-2.6). Asthma and obesity remained significant predictors when analysed simultaneously by logistic regression analysis. One hundred and fifty-two children with asthma consented to an oesophageal pH study, and an abnormal pH study result (reflux index > 5.0) correlated positively with overweight (OR 4.9, 95% CI 2.2-11.0)., Conclusion: The prevalence of symptoms associated with gastro-oesophageal reflux was increased in children with asthma and in overweight children. Overweight and asthma were independently associated with GERD symptoms, and overweight did not explain the higher frequency of GERD in asthma patients.

Unlabelled: Primary cutaneous aspergillosis is a rare diagnosis. Predisposing factors are immunodeficiency and macerated skin. The mortality of infections with Aspergillus species is high, especially in neonatal intensive care units (NICUs). We present a premature (24 wk of gestation) infant with primary cutaneous aspergillosis appearing on the sixth day of life. Predisposing factors in this patient were prematurity, extremely vulnerable skin, treatment with antibiotics and renovation in the radiology department nearby. The patient was treated with amphotericin B intravenously for a total of 40 d. He did not have, nor develop, disseminated aspergillosis, and suffered no side effects from the treatment. The only remaining trace of his infection was scarring in the affected area., Conclusion: After having treated this patient successfully and having gone through the available literature, we conclude that treating primary cutaneous aspergillosis with intravenous amphotericin B prevents disseminated aspergillosis and is the treatment of choice.

To explore the long-term prognosis for children referred for recurrent abdominal pain (RAP), 44 children investigated for RAP 5 y ago were compared to a group of controls (n=88). The former RAP patients reported RAP, headache and school absence more frequently than controls. A high proportion of children referred with RAP have persistent symptoms, with more headache and school absence than controls. The diagnostic subgroup did not predict persistence of abdominal pain.