The predictive value of the individual components of the metabolic syndrome for insulin resistance in obese children.

Background/aims: The usefulness of the concept of the metabolic syndrome (MS) in its current form has recently been questioned, and its association with insulin resistance is unknown. We assessed whether a multivariate model based on all components of MS expressed on a continuous scale would be a better predictor of a common marker of insulin resistance than the current dichotomous MS definitions.

Methods: Data from 78 obese Dutch teenagers (age 13.

Recurrent abdominal pain in 200 children: somatic causes and diagnostic criteria.

Aim: To establish to what extent somatic causes can be found in children referred to secondary care with recurrent abdominal pain.

Methods: For 2 years, all consecutive patients (age 4-16 years) fulfilling Apley criteria, referred to secondary care, were included. After a diagnostic work-up, stepwise therapeutic interventions were performed.

The effect of family-based multidisciplinary cognitive behavioral treatment in children with obesity: study protocol for a randomized controlled trial.

Background: The prevalence of childhood obesity has increased rapidly during the last three decades in the Netherlands. It is assumed that mainly environmental factors have contributed to this trend. Parental overweight and low social economic status are risk factors for childhood obesity.

Clinical and laboratory findings in 220 children with recurrent abdominal pain.

Aim:  To investigate the clinical and laboratory findings in children with recurrent abdominal pain (RAP).

Methods: Consecutive patients with RAP (Apley criteria), age 4-16 years, referred to a secondary medical centre were evaluated by a standardized history, physical examination and laboratory tests. The tests encompassed Helicobacter pylori (Hp), gastrointestinal bacterial infections, protozoa, coeliac disease, carbohydrate malabsorption, food intolerance, abdominal ultrasound and plain abdominal X-ray.

Long-term effect of lifestyle intervention on adiposity, metabolic parameters, inflammation and physical fitness in obese children: a randomized controlled trial.

Background: Behavioral lifestyle intervention, combined with parental involvement, is preferred over standard care or self-help in childhood obesity. The short-term results of such interventions are promising, but long-term follow-up results are equivocal.

Objective: The objective of the present study was the short (3 months) and long-term (1 and 2 years follow-up) effect evaluation of a family-based multidisciplinary cognitive behavioral lifestyle intervention on markers of adiposity, metabolism, inflammation and physical fitness compared with standard care in children with obesity.

Timing of group B streptococcus screening in pregnancy: a systematic review.

Background: Group B streptococcus (GBS) is an important cause of neonatal sepsis. Guidelines advise to collect cultures at 35-37 weeks' gestation and to administer intrapartum antibiotic prophylaxis in case of GBS-positive cultures, as well as in all preterm deliveries. Improved effectiveness of antenatal cultures might help to further decrease GBS early-onset disease.

Feasibility and reliability of PRISMA-medical for specialty-based incident analysis.

Aims And Objectives: In this study, the feasibility and reliability of the Prevention Recovery Information System for Monitoring and Analysis (PRISMA)-Medical method for systematic, specialty-based analysis and classification of incidents in the neonatal intensive care unit (NICU) were determined.

Methods: After the introduction of a Neonatology System for Analysis and Feedback on Medical Events (NEOSAFE) in eight tertiary care NICUs and one paediatric surgical ICU, PRISMA-Medical was started to be used to identify root causes of voluntary reported incidents by multidisciplinary unit patient safety committees. Committee members were PRISMA-trained and familiar with the department and its processes.

Why does meconium cause meconium aspiration syndrome? Current concepts of MAS pathophysiology.

One in every 7 pregnancies ends with meconium-stained amniotic fluid and approximately 5% of these infants develop the meconium aspiration syndrome (MAS). MAS is a severe disease of the (mainly) term neonate, characterized by respiratory distress, pulmonary inflammation, persistent pulmonary hypertension and chronic hypoxia. The pathophysiology of MAS is multifactorial and complex.

Delayed hemolytic transfusion reaction with hyperhemolysis after first red blood cell transfusion in child with beta-thalassemia: challenges in treatment.

Background: Delayed hemolytic transfusion reaction (DHTR) can manifest with hyperhemolysis, a serious complication of red blood cell (RBC) transfusions. This has mostly been described in sickle cell anemia but occasionally in beta-thalassemia. Treatment is challenging; immunosuppressive medication has been reported to be useful by some but not others.

Meconium-stained amniotic fluid: discharge vigorous newborns.

Background: Most infants born through meconium-stained amniotic fluid (MSAF) are observed clinically for 24 h postnatally. Only 5% of infants born through MSAF develop the meconium aspiration syndrome (MAS), a serious condition requiring medical intervention.

Objective: To evaluate the value of 24-h postnatal observation of infants born through MSAF.

Imaging of acute appendicitis in children: EU versus U.S. ... or US versus CT? A European perspective.

There is substantial evidence that imaging may reduce the negative appendectomy rate, also in children. However, controversy exists about the preferred method: US or CT, and the choice appears to be determined by the side of the Atlantic Ocean. This review brings forth several arguments in favour of US.

A visual analog scale can assess the effect of surgical treatment in children with chronic otitis media with effusion.

Background: The OM-6 survey is a validated and multinationally accepted instrument to measure the treatment effect of otitis media in children. Routine use of the OM-6 in a busy general practice is not always possible and can lead to incomplete returned surveys. A simplified method is favoured when the aim is a continuous process of complete treatment-outcome-data collection.

Axillary and rectal temperature measurements poorly agree in newborn infants.

Aim: Evaluation of the agreement between axillary temperature measurements and rectal temperature measurements in neonates.

Methods: Rectal and axillary body temperatures were simultaneously measured for 3 min in 33 neonates (gestational age 25-42 weeks, weight 840-4,005 g). Two investigators performed paired measurements, one in each neonate.

A 5-year follow-up study after knee disarticulation in two cases of Gollop-Wolfgang complex.

The Gollop-Wolfgang Complex is a very rare anomaly, which has its essential features in congenital absence of the tibia and ipsilateral bifurcation of the femur. Surgical treatment of two patients with a follow-up of 5 years is reported.

Status epilepticus in children with epilepsy: Dutch study of epilepsy in childhood.

Purpose: To study course and outcome of epilepsy in children having had a status epilepticus (SE) as the presenting sign or after the diagnosis.

Methods: A total of 494 children with newly diagnosed epilepsy, aged 1 month through 15 years, were followed prospectively for 5 years.

Results: A total of 47 Children had SE.

Urinary eosinophil protein X in children with atopic asthma.

Unlabelled: The aim of this study was to investigate the relationship between urinary eosinophil protein X (uEPX) and asthma symptoms, lung function, and other markers of eosinophilic airway inflammation in asthmatic school children.

Methods: A cross-sectional study was performed in 180 steroid dependent atopic children with stable moderately severe asthma, who were stable on 200 or 500 microg of fluticasone per day. uEPX was measured in a single sample of urine and was normalized for creatinine concentration (uEPX/c).

Long-term asthma treatment guided by airway hyperresponsiveness in children: a randomised controlled trial.

Management plans for childhood asthma show limited success in optimising asthma control. The aim of the present study was to assess whether a treatment strategy guided by airway hyperresponsiveness (AHR) increased the number of symptom-free days and improved lung function in asthmatic children, compared with a symptom-driven reference strategy. In a multicentre, double-blind, parallel-group, randomised, 2-yr intervention trial, 210 children (aged 6-16 yrs) with moderate atopic asthma, selected on the basis of symptom scores and/or the presence of AHR, were studied.

Recombinant human deoxyribonuclease in infants with respiratory syncytial virus bronchiolitis.

Background: Treatment of hospitalized infants with respiratory syncytial virus (RSV) bronchiolitis is mainly supportive. Bronchodilators and systemic steroids are often used but do not reduce the length of hospital stay. Because hypoxia and airways obstruction develop secondary to viscous mucus in infants with RSV bronchiolitis, and because free DNA is present in RSV mucus, we tested the efficacy of the mucolytic drug recombinant human deoxyribonuclease (rhDNase).

Can pyloromyotomy for infantile hypertrophic pyloric stenosis be performed in any hospital? Results from two teaching hospitals.

In order to document the incidence of perioperative complications in patients with infantile hypertrophic pyloric stenosis, a descriptive cohort study was performed in two teaching hospitals in the Netherlands. One hospital specialized in pediatric surgery and the other was a general surgery teaching hospital. All consecutive infants who underwent pyloromyotomy for the diagnosis hypertrophic pyloric stenosis in both hospitals between 1998 and 2002 were included.

Success with hydrostatic reduction of intussusception in relation to duration of symptoms.

Background: It is widely believed that hydrostatic reduction of intussusception is less successful in children with prolonged symptoms prior to presentation.

Aim: To prospectively evaluate success in relation to duration of symptoms.

Methods: Prospective study in which children, regardless of symptom duration, underwent an attempt at hydrostatic reduction.

US features of the normal appendix and surrounding area in children.

Purpose: To evaluate prospectively the frequency of depiction with ultrasonography (US) of the appendix in children without clinical suspicion of acute appendicitis and to evaluate the US appearance of the normal appendix.

Materials And Methods: Between March 2003 and July 2003, 146 consecutive patients (62 boys and 84 girls; mean age, 7 years; age range, 2-15 years) without clinical suspicion of acute appendicitis were examined with US. Patients with cystic fibrosis and those with acute abdominal pain were excluded from the study.

Appendix in children with cystic fibrosis: US features.

Purpose: To evaluate the ultrasonographic (US) appearance of the appendix in children with cystic fibrosis but who were asymptomatic for appendicitis.

Materials And Methods: Between March 2001 and March 2002, 31 children (14 boys, 17 girls; mean age, 9.5 years; range, 2-16 years) with cystic fibrosis underwent graded-compression US of the appendix.

The triplane variant of the tibial apophyseal fracture: a case report and a review of the literature.

A rare case of tibial apophyseal fracture with extension in the antero-lateral physis and epiphysis in a 17-year-old boy is described. This type of fracture, which can be associated with intra-articular lesions and lesions of the extensor mechanism, resembles the better known distal tibial triplane fracture. Arthroscopic controlled anatomic reduction with restoration of the articular surface was achieved.

Meconium is a source of pro-inflammatory substances and can induce cytokine production in cultured A549 epithelial cells.

Inflammation plays an important role in the pathogenesis of meconium aspiration syndrome, and pneumonitis is one of the major characteristics. We have previously shown that meconium has chemotactic properties because of the presence of IL-8. We hypothesize that IL-8 and other proinflammatory substances in meconium may amplify inflammation in meconium aspiration syndrome, inducing endogenous cytokine production by lung epithelial cells.

Parent-reported subjective complaints in children using antiepileptic drugs: what do they mean?

We used a parent-completed 20-item "side effect scale" quantifying complaints that parents perceive to be caused by antiepileptic drugs (AEDs) in 108 children with active epilepsy. We studied the associations between parent-reported complaints, severity of seizures, and restrictions due to epilepsy, and clinical data including number and AED load. In 85% of the children at least one complaint was reported, in less than 20% complaints were perceived as a substantial problem.