Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national Arthritis and Biologics in Children Register.

Background: Treatment of juvenile idiopathic arthritis (JIA) has changed dramatically since the introduction of biological agents in 1999.

Objective: To evaluate trends in prescription patterns of biological agents and the subsequent outcome of JIA.

Methods: The Arthritis and Biologics in Children register (multicentre prospective observational study) aimed to include all consecutive patients with JIA in the Netherlands who had started biological agents since 1999.

Improving the Manchester Triage System for pediatric emergency care: an international multicenter study.

Objectives: This multicenter study examines the performance of the Manchester Triage System (MTS) after changing discriminators, and with the addition use of abnormal vital sign in patients presenting to pediatric emergency departments (EDs).

Design: International multicenter study.

Settings: EDs of two hospitals in The Netherlands (2006-2009), one in Portugal (November-December 2010), and one in UK (June-November 2010).

Occult constipation: faecal retention as a cause of recurrent abdominal pain in children.

Unlabelled: Recurrent abdominal pain (RAP) in children is generally believed to be functional. In practice, many children with RAP become pain-free with laxative therapy. The aims of the study were to establish the role of (occult) constipation in RAP and to investigate whether patients diagnosed with (occult) constipation could be identified by history and physical examination.

The influences of factors associated with decreased iron supply to the fetus during pregnancy on iron status in healthy children aged 0.5 to 3 years.

Objective: To investigate whether maternal anemia, pregnancy-induced diabetes, hypertension and smoking contributed to the recently found high prevalence of iron deficiency in a population of otherwise healthy children.

Study Design: Iron status was assessed in 400 children aged 0.5 to 3 years.

Mechanical ventilation drives inflammation in severe viral bronchiolitis.

Introduction: Respiratory insufficiency due to severe respiratory syncytial virus (RSV) infection is the most frequent cause of paediatric intensive care unit admission in infants during the winter season. Previous studies have shown increased levels of inflammatory mediators in airways of mechanically ventilated children compared to spontaneous breathing children with viral bronchiolitis. In this prospective observational multi-center study we aimed to investigate whether this increase was related to disease severity or caused by mechanical ventilation.

Accuracy of a screening instrument to identify potential child abuse in emergency departments.

Although screening for child abuse at emergency departments (EDs) increases the detection rate of potential child abuse, an accurate instrument is lacking. This study was designed to measure the accuracy of a screening instrument for detection of potential child abuse used in EDs. In a prospective cohort study at three Dutch EDs, a 6-item screening instrument for child abuse, Escape, was completed for each child visiting the ED.

Prevalence and risk factors of iron deficiency in healthy young children in the southwestern Netherlands.

Objectives: Iron deficiency (ID) and iron deficiency anemia (IDA), during the first years of life, are associated with delayed motor and neurological development. Many studies evaluated iron status without an assessment of an acute-phase protein to identify infection. Because most indicators of iron status are influenced by infection, these data may underestimate the ID prevalence.

Painful paediatric hip: frog-leg lateral view only!

Objective: For hip complaints in the paediatric population, it is common practice to acquire both anteroposterior (AP) and frog-leg lateral (FL) radiographs. This combination of views provides a high diagnostic yield, but also doubles radiation exposure. We investigated the diagnostic accuracy of obtaining a solitary FL view as compared to a combination of the AP and FL view.

Iron deficiency occurs frequently in children with cystic fibrosis.

In adult CF patients iron deficiency (ID) is common and primarily functional due to chronic inflammation. No recent data are available on the cause of ID and iron deficiency anemia (IDA) in children with CF. Over the last decades onset of inflammation and pulmonary disease in children with CF is delayed by improved nutritional status.

Electronic collimation and radiation protection in paediatric digital radiography: revival of the silver lining.

In digital radiography we are now able to electronically collimate images after acquisition. This may seem convenient in paediatric imaging, but we have to be aware that electronic collimation has two major downsides. Electronic collimation implicates that the original field size should have been smaller and the child has been exposed to unnecessary radiation.

Protozoa as a cause of recurrent abdominal pain in children.

Objectives: The aim of this study was to investigate whether protozoa can be identified as a cause of recurrent abdominal pain (RAP), and whether protozoan infections can be recognized by a specific clinical presentation.

Methods: For 2 years, all patients (ages 4-16 years) fulfilling the Apley criteria of RAP referred to secondary care were prospectively evaluated for protozoa (Giardia lamblia, Dientamoeba fragilis, Blastocystis hominis) and treated if positive. Re-examination followed at least 10 days after treatment.

Will symptom-based therapy be effective for treating asthma in children?

Traditionally, symptoms are important patient-oriented outcomes in asthma treatment, and assessment of symptoms is an essential component of assessing asthma control. However, variable airways obstruction, airways hyperresponsiveness and chronic inflammation are key components of the asthma syndrome, and correlations among these hallmarks and symptoms are weak or even absent. Therefore, it might be questioned if symptom-based therapy is effective for treating asthma in (all) children.

Long-term follow-up after two years of asthma treatment guided by airway responsiveness in children.

Introduction: Children with persistent asthma may have diminished lung function in early adulthood. In our previous study ('CATO') we showed preservation of lung function in asthmatic children, during 2 years of treatment that was guided by airway hyperresponsiveness (AHR). The aim of the present prospective follow up study was to investigate whether the positive effect of the AHR strategy on lung function had persisted beyond the duration of the intervention study, after several years of usual care by paediatrician and general practitioner.

Perception of bronchoconstriction: a complementary disease marker in children with asthma.

Introduction: Asthma guidelines use symptoms as the most important aspect of asthma control. Symptom perception varies widely between individuals. Over-perception as well as underperception of bronchoconstriction could have a negative effect on asthma management.

Rare but numerous serious complications of acute otitis media in a young child.

Acute otitis media is a very common disease in children. Most children recover with symptomatic therapy like potent analgesics, but occasionally serious complications occur. We present a 3-year-old girl who suffered from acute otitis media for already 2 weeks and presented with fever, abducens nerve palsy of her left eye and vomiting.

How to use... neonatal TORCH testing.

Toxoplasma gondii, rubella, cytomegalovirus and herpes simplex virus have in common that they can cause congenital (TORCH) infection, leading to fetal and neonatal morbidity and mortality. During the last decades, TORCH screening, which is generally considered to be single serum testing, has been increasingly used inappropriately and questions have been raised concerning the indications and cost-effectiveness of TORCH testing. The problems of TORCH screening lie in requesting the screening for the wrong indications, wrong interpretation of the single serum results and in case there is a good indication for diagnosis of congenital infection, sending in the wrong materials.

Urinary eosinophil protein X in childhood asthma: relation with changes in disease control and eosinophilic airway inflammation.

The aim of this study was to assess cross-sectional and longitudinal correlations between uEPX and other markers of asthma control and eosinophilic airway inflammation. Methods. We measured uEPX at baseline, after 1 year and after 2 years in 205 atopic asthmatic children using inhaled fluticasone.

Persistent Mullerian duct syndrome: a rare cause of unilateral cryptorchidism.

Persistent Mullerian duct syndrome (PMDS) is a rare syndrome and sometimes the cause of a common problem in paediatric and surgical practice, namely undescended testes. PMDS is a recessive disease in which there is a defect in anti-Mullerian hormone secretion or receptor activity resulting in persistence of Mullerian structures such as a uterus or fallopian tubes with otherwise normal virilisation. Here the authors present a case of a 1½-year-old boy who was referred to their hospital because of unilateral cryptorchidism.

Ulcerative colitis presenting as acute infectious gastroenteritis with a paralytic ileus.

A 15-year-old girl who presented with signs of acute infectious gastroenteritis, just as two members of her family is described. As the patient did not improve, a sigmoidoscopy was performed and the diagnosis of ulcerative colitis (UC) was made. Our hypothesis is that an infection triggered the development of UC.

Lactose and fructose malabsorption in children with recurrent abdominal pain: results of double-blinded testing.

Aim: To investigate malabsorption of lactose and fructose as causes of recurrent abdominal pain (RAP).

Methods: In 220 children (128 girls, mean age 8,8 [4.1-16.

Intrauterine transfusion for parvovirus B19 infection: long-term neurodevelopmental outcome.

Objective: To evaluate long-term neurodevelopmental outcome of children treated with intrauterine transfusions for fetal anemia because of parvovirus B19 infection.

Study Design: Children treated with intrauterine transfusions for fetal anemia because of parvovirus B19 infection underwent standardized age-appropriate neurodevelopmental testing. Main outcome was the incidence of neurodevelopmental impairment.

The effect of multidisciplinary lifestyle intervention on the pre- and postprandial plasma gut Peptide concentrations in children with obesity.

Objective. This study aims to evaluate the effect of a multidisciplinary treatment of obesity on plasma concentrations of several gut hormones in fasting condition and in response to a mixed meal in children. Methods.

The validity of biochemical markers in metabolic bone disease in preterm infants: a systematic review.

Unlabelled: To establish the validity of biochemical markers of metabolic bone disease (MBD) in preterm infants.

Conclusion: There is insufficient evidence that any of the frequently used serum measurements are valid biochemical markers of MBD in preterm infants. Increased urinary calcium concentration may be a valid biochemical marker, but more research is necessary to confirm this.

The effect of family-based multidisciplinary cognitive behavioral treatment on health-related quality of life in childhood obesity.

Purpose: To evaluate the effect of multidisciplinary treatment on obesity and health-related quality of life (HRQOL).

Methods: Obese children were randomized to a multidisciplinary lifestyle treatment, including medical, nutritional, physical, and psychological counseling during 3 months, (n = 40, BMI-SDS; 4.2 ± 0.