The use of in-hospital guidelines for prevention of sudden unexpected postnatal collapse: A national survey.

Aim: Sudden unexpected postnatal collapse is a life-threatening event and may occur in any newborn infant. Safe skin-to-skin contact, and awareness of sudden unexpected postnatal collapse are key to its prevention. The aim of this study was to survey the presence of skin-to-skin contact and/or sudden unexpected postnatal collapse protocols in the 70 perinatal centres in the Netherlands.

[Rat bite fever in children].

Background: Worldwide, disease in children due to exposure to rats is increasing, also in the Netherlands. Not only the generally known pathogen Leptospira should be considered, also , , Lymphocytic choriomeningitis virus, Hantavirus, and are also known rat-associated zoonosis.

Case Description: An 12-year-old boy visited the pediatrician with fever, headache and nausea, followed by generalized erythema and arthritis.

A Systematic Approach to Evaluate Sudden Unexplained Death in Children.

Objective: To evaluate in the Netherlands the national outcomes in providing cause of and insights into sudden and unexplained child deaths among children via the Postmortem Evaluation of Sudden Unexplained Death in Youth (PESUDY) procedure.

Study Design: Children aged 0-18 years in the Netherlands who died suddenly were included in the PESUDY procedure if their death was unexplained and their parents gave consent. The PESUDY procedure consists of pediatric and forensic examination, biochemical, and microbiological tests; radiologic imaging; autopsy; and multidisciplinary discussion.

[Infants with an unexplained event: management of brief resolved unexplained events revised].

In this article, the new Dutch pediatric guideline Brief Resolved Unexplained Event is discussed, which replaces the old guideline Apparent Life Threatening Event. The main goal of the new guideline is identification of a group of low-risk infants who need not be admitted to the hospital and in which only limited diagnostic workup is indicated. Three fictional cases are presented to highlight the major changes in management of infants who present with an unexplained event.

Lower versus Traditional Treatment Threshold for Neonatal Hypoglycemia.

Background: Worldwide, many newborns who are preterm, small or large for gestational age, or born to mothers with diabetes are screened for hypoglycemia, with a goal of preventing brain injury. However, there is no consensus on a treatment threshold that is safe but also avoids overtreatment.

Methods: In a multicenter, randomized, noninferiority trial involving 689 otherwise healthy newborns born at 35 weeks of gestation or later and identified as being at risk for hypoglycemia, we compared two threshold values for treatment of asymptomatic moderate hypoglycemia.

Macrolide prescription in Dutch children: compliance with guidelines.

For reasons of antibiotic resistance and side effects, macrolides should be prescribed with care in the pediatric population. We evaluated the adherence to Dutch guidelines of macrolide prescription in children and estimated the risk of Mycoplasma pneumoniae-associated pneumonia based on Fischer's decision tree. In this retrospective study, we included children aged 0-18 years who were treated with azithromycin or clarithromycin for pulmonary disease in four settings from general practice to hospital ward for (1) the prescriptions not in accordance with the guideline of the Dutch Association of Pediatrics and (2) the risk of M.

[A girl looking pregnant].

We describe a 13-year-old girl with abdominal complaints and looking pregnant. MRI investigation showed an adnexal mass (28 x 19 x 12 cm), which was surgically removed. Histolpathological investigation revealed a mature cystic teratoma with no signs of malignant transformation.

[A 9-year-old boy with 'pinpoint pain' caused by pyomyositis].

Background: Pyomyositis is a rare bacterial infection of striated muscle, usually caused by Staphylococcus aureus.

Case Description: A healthy 9-year-old boy was referred to us because of pain in the hip and fever. We noticed he could point to the pain with one finger; this is referred to as 'pinpoint pain'.

[Skin to skin contact and breast-feeding after birth: not always without risk!].

Skin-to-skin contact after birth is propagated to facilitate breast-feeding and mother-child bonding. We describe two term infants with sudden unexpected postnatal collapse (SUPC) during skin-to-skin contact. The infants were found with abnormal colour, hypotonia and apnoea, in a prone position on the chest of their mothers, both of whom were primipara with a high BMI.

Serum concentrations of amoxicillin in neonates during continuous intravenous infusion.

Amoxicillin is commonly used for the treatment of neonatal bacterial infection with intermittent dosing (ID) regimens. However, increasing bacterial resistance, in addition to a lack of new antimicrobial agents, urges the optimization of current therapeutic options. Clinical studies in adults suggest continuous infusion (CI) regimens of beta-lactam antibiotics to be superior to ID.

Time-course analysis of 3-epi-25-hydroxyvitamin D3 shows markedly elevated levels in early life, particularly from vitamin D supplementation in preterm infants.

Background: An epimeric form of 25-hydroxyvitamin D3 (25(OH)D3) has recently been detected in clinical samples, with relatively high levels in infants. Little is known on 3-epi-25(OH)D3 formation and physiological function. Our objective was to study dynamics of 3-epi-25(OH)D3 formation during infancy.

Ultrasound of the cervical roots and brachial plexus in neonates.

Introduction: In this exploratory study we investigated whether ultrasound can visualize the neonatal cervical roots and brachial plexus.

Methods: In 12 healthy neonates <2 days old, the neck region was studied unilaterally with ultrasound using a small-footprint 15-7-MHz transducer.

Results: The C5-C8 nerve roots and brachial plexus could be imaged with sufficient delineation of the root exits to assess their integrity.

Umbilical choline and related methylamines betaine and dimethylglycine in relation to birth weight.

Background: Low birth weight (LBW) is associated with increased morbidity and mortality for the newborn and risk of chronic disease in adulthood. Choline plays an essential role in the integrity of cell membranes, methylation reactions, and memory development. We examined whether choline, betaine, and dimethylglycine (DMG) concentrations were associated with LBW in Dutch women.

[Additional recommendations for safe sleep to prevent SIDS].

Great progress has been made in reducing the incidence of SIDS in the Netherlands, but the number of SIDS cases has remained constant in recent years. The American Academy of Pediatrics has new guidelines for safe sleep. Existing recommendations remain valid such as (a) discouraging prone- and side-sleeping; (b) encouraging parent and child to sleep in one room but not in one bed; and (c) avoiding second-hand smoke.

Mutations in kelch-like 3 and cullin 3 cause hypertension and electrolyte abnormalities.

Hypertension affects one billion people and is a principal reversible risk factor for cardiovascular disease. Pseudohypoaldosteronism type II (PHAII), a rare Mendelian syndrome featuring hypertension, hyperkalaemia and metabolic acidosis, has revealed previously unrecognized physiology orchestrating the balance between renal salt reabsorption and K(+) and H(+) excretion. Here we used exome sequencing to identify mutations in kelch-like 3 (KLHL3) or cullin 3 (CUL3) in PHAII patients from 41 unrelated families.

[Congenital toxoplasmosis: severe ocular and neurological complications].

Two infants with congenital toxoplasmosis are presented. A girl born prematurely was treated postnatally after the mother had received antimicrobial treatment during pregnancy for acute toxoplasmosis. Apart from being small for gestational age, she remained without symptoms and treatment was ceased after 13 months.

Maternal homocysteine and related B vitamins as risk factors for low birthweight.

Objective: We designed a large prospective study to explore the relationship between maternal homocysteine concentrations and related B vitamins and birthweight.

Study Design: Blood was sampled from pregnant women at 30-34 weeks of gestation and their newborn infants (n = 366).

Results: Concentrations of all analytes were higher in umbilical cord compared with maternal samples.

[Multidisciplinary guidelines for 'Apparent life threatening event' (ALTE)].

In order to reach a consensus concerning diagnosis, support and follow-up in children with an 'apparent life threatening event' (ALTE) multidisciplinary guidelines have been developed by the Dutch Paediatric Association and the Dutch Institute for Healthcare Improvement (CBO). All children presenting as an emergency with ALTE should undergo inpatient clinical observation for 24-72 h, with at least 24 h of cardio-respiratory monitoring. Observation does not need to be continued once an explanation for the incident has been established.

Surveillance study of apparent life-threatening events (ALTE) in the Netherlands.

SIDS and ALTE are different entities that somehow show some similarities. Both constitute heterogeneous conditions. The Netherlands is a low-incidence country for SIDS.

Serum concentrations of cefotaxime and its metabolite desacetyl-cefotaxime in infants and children during continuous infusion.

Introduction: Continuous infusion of cefotaxime, as opposed to intermittent infusion, seems to be advantageous for a number of reasons. However, few data exist on pharmacokinetics of cefotaxime and its metabolite in infants and children. As part of a quality assessment program, concentrations of cefotaxime and its metabolite desacetyl-cefotaxime were examined.

[More cot deaths in child care settings than during the same hours at home: 10-year statistics].

Objective: To determine whether the incidence of sudden infant death syndrome (SIDS) in child care settings (child care centres or child minders) is different from that in the home setting, and to search for any differences in the prevalence of SIDS risk factors in both settings.

Design: Descriptive and comparative.

Method: All SIDS cases (< 2 years), that occurred between September 1996-August 2006 and known to the 'Landelijke Werkgroep Wiegendood' (the National Cot Death Study Group) of the Dutch Paediatric Association were analysed.