BioMed Research International: Pediatrics http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Red Cell Distribution Width as a Prognostic Indicator in Pediatric Heart Disease and after Surgery Wed, 12 Mar 2014 13:09:43 +0000 http://www.hindawi.com/journals/bmri/2014/681679/ Background. Red cell distribution width (RDW) is an important marker which reflects inflammatory activity in many chronic diseases. The objective of this study is to investigate the impact of RDW on morbidity and mortality before and after pediatric congenital heart surgery. Methods. 107 patients with congenital heart disease, cardiac case group, and 70 patients, control group, without heart disease were retrospectively analyzed. Pre-, and postoperative and at discharge RDW of the cardiac patients were determined. Lengths of hospital and intensive care unit (ICU) stay and exited patients were determined. Results. Mean lengths of ICU and hospital stay were and days. In control group, mean preoperative RDW was , while in cardiac case group it was significantly higher (). In cardiac case group, postoperative RDW were significantly higher than preoperative period, while RDW at discharge were significantly lower than postoperative estimates. A significant and a positive correlation was detected between lengths of ICU and hospital stay and RDW. RDW of the exited patients were significantly higher than the survivors. Conclusions. This study demonstrates that RDW can be used as an important indicator in the prediction of morbidity and mortality during pre-, and postoperative period of the pediatric congenital heart disease surgery. Vural Polat, Sahin Iscan, Mustafa Etli, Helin El Kılıc, Özgür Gürsu, Esra Eker, and Fatih Ozdemir Copyright © 2014 Vural Polat et al. All rights reserved. Acute Kidney Injury in Neonates: From Urine Output to New Biomarkers Wed, 05 Mar 2014 16:39:15 +0000 http://www.hindawi.com/journals/bmri/2014/601568/ In the past 10 years, great effort has been made to define and classify a common syndrome previously known as acute renal failure and now renamed “acute kidney injury (AKI).” Initially suggested and validated in adult populations, AKI classification was adapted to the pediatric population and recently has been modified for the neonatal population. Several studies have been performed in adults and older children using this consensus definition, leading to improvement in the knowledge of AKI incidence and epidemiology. In spite of these advances, the peculiar renal pathophysiology of critically ill newborn patients makes it difficult to interpret urine output (UO) and serum creatinine (SCr) levels in these patients to diagnose AKI. Also, new urine biomarkers have emerged as a possible alternative to diagnose early AKI in the neonatal population. In this review, we describe recent advances in neonatal AKI epidemiology, discuss difficulties in diagnosing AKI in newborns, and show recent advances in new AKI biomarkers and possible long-term consequences after AKI episode. Alexandre Braga Libório, Klébia Magalhães Pereira Castello Branco, and Candice Torres de Melo Bezerra Copyright © 2014 Alexandre Braga Libório et al. All rights reserved. Drug Resistance Mechanisms of Mycoplasma pneumoniae to Macrolide Antibiotics Tue, 28 Jan 2014 09:20:32 +0000 http://www.hindawi.com/journals/bmri/2014/320801/ Throat swabs from children with suspected Mycoplasma pneumoniae (M. pneumoniae) infection were cultured for the presence of M. pneumoniae and its species specificity using the 16S rRNA gene. Seventy-six M. pneumoniae strains isolated from 580 swabs showed that 70 were erythromycin resistant with minimum inhibitory concentrations (MIC) around 32–512 mg/L. Fifty M. pneumoniae strains (46 resistant, 4 sensitive) were tested for sensitivity to tetracycline, ciprofloxacin, and gentamicin. Tetracycline and ciprofloxacin had some effect, and gentamicin had an effect on the majority of M. pneumoniae strains. Domains II and V of the 23S rRNA gene and the ribosomal protein L4 and L22 genes, both of which are considered to be associated with macrolide resistance, were sequenced and the sequences were compared with the corresponding sequences in M129 registered with NCBI and the FH strain. The 70 resistant strains all showed a 2063 or 2064 site mutation in domain V of the 23S rRNA but no mutations in domain II. Site mutations of L4 or L22 can be observed in either resistant or sensitive strains, although it is not known whether this is associated with drug resistance. Xijie Liu, Yue Jiang, Xiaogeng Chen, Jing Li, Dawei Shi, and Deli Xin Copyright © 2014 Xijie Liu et al. All rights reserved. Patent Ductus Arteriosus in Preterm Infants: Do We Have the Right Answers? Mon, 23 Dec 2013 14:48:07 +0000 http://www.hindawi.com/journals/bmri/2013/676192/ Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants. Preterm newborns with PDA are at greater risk for several morbidities, including higher rates of bronchopulmonary dysplasia (BPD), decreased perfusion of vital organs, and mortality. Therefore, cyclooxygenase (COX) inhibitors and surgical interventions for ligation of PDA are widely used. However, these interventions were reported to be associated with side effects. In the absence of clear restricted rules for application of these interventions, different strategies are adopted by neonatologists. Three different approaches have been investigated including prophylactic treatment shortly after birth irrespective of the state of PDA, presymptomatic treatment using echocardiography at variable postnatal ages to select infants for treatment prior to the duct becoming clinically significant, and symptomatic treatment once PDA becomes clinically apparent or hemodynamically significant. Future appropriately designed randomized controlled trials (RCTs) to refine selection of patients for medical and surgical treatments should be conducted. Waiting for new evidence, it seems wise to employ available clinical and echocardiographic parameters of a hemodynamically significant (HS) PDA to select patients who are candidates for medical treatment. Surgical ligation of PDA could be used as a back-up tool for those patients who failed medical treatment and continued to have hemodynamic compromise. Hesham Abdel-Hady, Nehad Nasef, Abd Elazeez Shabaan, and Islam Nour Copyright © 2013 Hesham Abdel-Hady et al. All rights reserved. Association of Iron Depletion with Menstruation and Dietary Intake Indices in Pubertal Girls: The Healthy Growth Study Mon, 23 Dec 2013 10:12:39 +0000 http://www.hindawi.com/journals/bmri/2013/423263/ The aim of the present study was to investigate the associations of iron depletion (ID) with menstrual blood losses, lifestyle, and dietary habits, in pubertal girls. The study sample comprised 1222 girls aged 9–13 years old. Biochemical, anthropometrical, dietary, clinical, and physical activity data were collected. Out of 274 adolescent girls with menses, 33.5% were found to be iron depleted (defined as serum ferritin < 12 μg/L) compared to 15.9% out of 948 girls without menses. Iron-depleted girls without menses were found to have lower consumption of poultry () and higher consumption of fruits () and fast food () compared to their peers having normal iron status. Multivariate logistic regression analysis showed that girls with menses were 2.57 (95% CI: 1.37, 4.81) times more likely of being iron depleted compared to girls with no menses. Iron depletion was found to be associated with high calcium intake, high consumption of fast foods, and low consumption of poultry and fruits. Menses was the only factor that was found to significantly increase the likelihood of ID in these girls. More future research is probably needed in order to better understand the role of diet and menses in iron depletion. George Moschonis, Dimitrios Papandreou, Christina Mavrogianni, Angeliki Giannopoulou, Louisa Damianidi, Pavlos Malindretos, Christos Lionis, George P. Chrousos, and Yannis Manios Copyright © 2013 George Moschonis et al. All rights reserved. Ultrastructural Study of Alveolar Epithelial Type II Cells by High-Frequency Oscillatory Ventilation Tue, 10 Dec 2013 12:53:45 +0000 http://www.hindawi.com/journals/bmri/2013/240659/ Alveolar epithelial type II cells (AECIIs) containing lamellar bodies (LBs) are alveolar epithelial stem cells that have important functions in the repair of lung structure and function after lung injury. The ultrastructural changes in AECIIs after high-frequency oscillatory ventilation (HFOV) with a high lung volume strategy or conventional ventilation were evaluated in a newborn piglet model with acute lung injury (ALI). After ALI with saline lavage, newborn piglets were randomly assigned into five study groups (three piglets in each group), namely, control (no mechanical ventilation), conventional ventilation for 24 h, conventional ventilation for 48 h, HFOV for 24 h, and HFOV for 48 h. The lower tissues of the right lung were obtained to observe the AECII ultrastructure. AECIIs with reduced numbers of microvilli, decreased LBs electron density, and vacuole-like LBs deformity were commonly observed in all five groups. Compared with conventional ventilation groups, the decrease in numbers of microvilli and LBs electron density, as well as LBs with vacuole-like appearance and polymorphic deformity, was less severe in HFOV with high lung volume strategy groups. AECIIs were injured during mechanical ventilation. HFOV with a high lung volume strategy resulted in less AECII damage than conventional ventilation. Xiaofei Qin, Wanhai Fu, Youwei Zhao, Qiong Meng, Chuming You, and Qiuming Yu Copyright © 2013 Xiaofei Qin et al. All rights reserved. S100A12 and hBD2 Correlate with the Composition of the Fecal Microflora in ELBW Infants and Expansion of E. coli Is Associated with NEC Wed, 06 Nov 2013 14:54:57 +0000 http://www.hindawi.com/journals/bmri/2013/150372/ Objective. To describe the development of the gut microbiota in extremely low birth weight (ELBW) infants with and without necrotizing enterocolitis (NEC) between April 2008 and December 2009, fecal microflora was prospectively analyzed in fecal samples of all ELBW infants using real-time PCR assays. In addition, fecal inflammatory were measured. Results. Fecal microflora established early in ELBW infants and microbiota composition remained stable over the first 28 days of life except for the prevalence of C. difficile which decreased with decreasing antibiotic use. Infants who subsequently developed NEC had an increase of total bacterial count (9.8-fold) 24 h prior to clinical symptoms mainly due to the expansion of E. coli species (21.6-fold), whereas microbiota composition did not differ from healthy ELBW infants five days before onset of NEC. Importantly, S100A12 and hBD2 positively correlated with the total and E. coli bacterial CFU/g feces ( 0.4 and 0.64, resp.). Conclusions. In summary, we found evidence for a disturbed homeostasis between the intestinal microbiome and host immunity in ELBW infants with NEC. Moreover, S100A12 and hBD2 correlate with the fecal microbiota thus linking the intestinal innate immune response to the bacterial colonization thus possibly providing a diagnostic tool in the future. A. C. Jenke, J. Postberg, B. Mariel, K. Hensel, D. Foell, J. Däbritz, and S. Wirth Copyright © 2013 A. C. Jenke et al. All rights reserved. Risk Factors for High-Titer Inhibitor Development in Children with Hemophilia A: Results of a Cohort Study Wed, 02 Oct 2013 08:43:27 +0000 http://www.hindawi.com/journals/bmri/2013/901975/ Among the discussed risk factors for high-titre inhibitor (HRI) development in patients with hemophilia A (HA) are high dose FVIII replacement therapy and use of recombinant FVIII concentrates (rFVIII). The aim of this study was to evaluate the aforementioned risk factors for HRI development in children with hemophilia A ≤2%. About 288 ascertained PUPs (Israel and Germany) were followed after initial HA diagnosis over 200 exposure days. Inhibitor-free survival, hazard ratios (HR), and 95% confidence intervals (CIs) were calculated. Adjustment was performed for factor VIII concentrates, median single dose over the first three months of treatment, first FVIII administration before the age of three months, presence of risk HA gene mutations, “intensive treatment moments” and “year of birth” (proxy for different treatment periods). HRI occurred in 71/288 children (24.7%). In multivariate analysis adjusted for “year of birth”, underlying risk gene mutations (HR/CI: 2.37/1.40–3.99), FVIII dose, measured per one IU increase per kgbw (HR/CI: 1.05/1.04–1.07), and first FVIII administration before the age of three months showed a significant impact on HR development. The risk of HRI development was similar for recombinant or plasmatic FVIII products. Children at risk should be treated with carefully calculated lower dose regimens, adapted to individual bleeding situations. Susan Halimeh, Christoph Bidlingmaier, Christine Heller, Sven Gutsche, Susanne Holzhauer, Gili Kenet, Karin Kurnik, Daniela Manner, Alfonso Iorio, and Ulrike Nowak-Göttl Copyright © 2013 Susan Halimeh et al. All rights reserved. The Role of Calprotectin in Pediatric Disease Mon, 23 Sep 2013 15:47:25 +0000 http://www.hindawi.com/journals/bmri/2013/542363/ Calprotectin (CP) is a calcium- and zinc-binding protein of the S100 family expressed mainly by neutrophils with important extracellular activity. The aim of the current review is to summarize the latest findings concerning the role of CP in a diverse range of inflammatory and noninflammatory conditions among children. Increasing evidence suggests the implication of CP in the diagnosis, followup, assessment of relapses, and response to treatment in pediatric pathological conditions, such as inflammatory bowel disease, necrotizing enterocolitis, celiac disease, intestinal cystic fibrosis, acute appendicitis, juvenile idiopathic arthritis, Kawasaki disease, polymyositis-dermatomyositis, glomerulonephritis, IgA nephropathy, malaria, HIV infection, hyperzincemia and hypercalprotectinemia, and cancer. Further studies are required to provide insights into the actual role of CP in these pathological processes in pediatrics. George Vaos, Ioannis D. Kostakis, Nick Zavras, and Athanasios Chatzemichael Copyright © 2013 George Vaos et al. All rights reserved. Who Receives Home-Based Perinatal Palliative Care: Experience from Poland Tue, 03 Sep 2013 15:47:23 +0000 http://www.hindawi.com/journals/bmri/2013/652321/ Context. The current literature suggests that perinatal palliative care (PPC) programs should be comprehensive, initiated early, and integrative. So far there have been very few publications on the subject of home-based PC of newborns and neonates. Most publications focus on hospital-based care, mainly in the neonatal intensive care units. Objective. To describe the neonates and infants who received home-based palliative care in Lodz Region between 2005 and 2011. Methods. A retrospective review of medical records. Results. 53 neonates and infants were admitted to a home hospice in Lodz Region between 2005 and 2011. In general, they are a growing group of patients referred to palliative care. Congenital diseases (41%) were the primary diagnoses; out of 53 patients 16 died, 20 were discharged home, and 17 stayed under hospice care until 2011. The most common cause of death (56%) was cardiac insufficiency. Neurological symptoms (72%) and dysphagia (58%) were the most common clinical problems. The majority of children (45%) had a feeding tube inserted and were oxygen dependent (45%); 39 families received psychological care and 31 social supports. Conclusions. For terminally ill neonates and infants, perinatal palliative care is an option which improves the quality of their lives and provides the family with an opportunity to say goodbye. Aleksandra Korzeniewska-Eksterowicz, Łukasz Przysło, Bogna Kędzierska, Małgorzata Stolarska, and Wojciech Młynarski Copyright © 2013 Aleksandra Korzeniewska-Eksterowicz et al. All rights reserved. Nonpharmacological Management of Gastroesophageal Reflux in Preterm Infants Sun, 01 Sep 2013 11:32:52 +0000 http://www.hindawi.com/journals/bmri/2013/141967/ Gastroesophageal reflux (GOR) is very common among preterm infants, due to several physiological mechanisms. Although GOR should not be usually considered a pathological condition, its therapeutic management still represents a controversial issue among neonatologists; pharmacological overtreatment, often unuseful and potentially harmful, is increasingly widespread. Hence, a stepwise approach, firstly promoting conservative strategies such as body positioning, milk thickening, or changes of feeding modalities, should be considered the most advisable choice in preterm infants with GOR. This review focuses on the conservative management of GOR in the preterm population, aiming to provide a complete overview, based on currently available evidence, on potential benefits and adverse effects of nonpharmacological measures. Nonpharmacological management of GOR might represent a useful tool for neonatologists to reduce the use of antireflux medications, which should be limited to selected cases of symptomatic babies. Luigi Corvaglia, Silvia Martini, Arianna Aceti, Santo Arcuri, Roberto Rossini, and Giacomo Faldella Copyright © 2013 Luigi Corvaglia et al. All rights reserved. Temperature and Drug Treatments in Mevalonate Kinase Deficiency: An Ex Vivo Study Sun, 01 Sep 2013 07:52:54 +0000 http://www.hindawi.com/journals/bmri/2013/715465/ Mevalonate Kinase Deficiency (MKD) is a rare autosomal recessive inborn disorder of cholesterol biosynthesis caused by mutations in the mevalonate kinase (MK) gene, leading to MK enzyme decreased activity. The consequent shortage of mevalonate-derived isoprenoid compounds results in an inflammatory phenotype, caused by the activation of the NALP3 inflammasome that determines an increased caspase-1 activation and IL-1β release. In MKD, febrile temperature can further decrease the residual MK activity, leading to mevalonate pathway modulation and to possible disease worsening. We previously demonstrated that the administration of exogenous isoprenoids such as geraniol or the modulation of the enzymatic pathway with drugs, such as Tipifarnib, partially rescues the inflammatory phenotype associated with the defective mevalonic pathway. However, it has not been investigated yet how temperature can affect the success of these treatments. Thus, we investigated the effect of temperature on primary human monocytes from MKD patients. Furthermore the ability of geraniol and Tipifarnib to reduce the abnormal inflammatory response, already described at physiological temperature in MKD, was studied in a febrile condition. We evidenced the role of temperature in the modulation of the inflammatory events and suggested strongly considering this variable in future researches aimed at finding a treatment for MKD. Paola Maura Tricarico, Giulio Kleiner, Elisa Piscianz, Valentina Zanin, Lorenzo Monasta, Sergio Crovella, and Annalisa Marcuzzi Copyright © 2013 Paola Maura Tricarico et al. All rights reserved. Antibodies against Food Antigens in Patients with Autistic Spectrum Disorders Thu, 01 Aug 2013 09:13:24 +0000 http://www.hindawi.com/journals/bmri/2013/729349/ Purpose. Immune system of some autistic patients could be abnormally triggered by gluten/casein assumption. The prevalence of antibodies to gliadin and milk proteins in autistic children with paired/impaired intestinal permeability and under dietary regimen either regular or restricted is reported. Methods. 162 ASDs and 44 healthy children were investigated for intestinal permeability, tissue-transglutaminase (tTG), anti-endomysium antibodies (EMA)-IgA, and total mucosal IgA to exclude celiac disease; HLA-DQ2/-DQ8 haplotypes; total systemic antibodies (IgA, IgG, and IgE); specific systemic antibodies: α-gliadin (AGA-IgA and IgG), deamidated–gliadin-peptide (DGP-IgA and IgG), total specific gliadin IgG (all fractions: α, β, γ, and ω), β-lactoglobulin IgG, α-lactalbumin IgG, casein IgG; and milk IgE, casein IgE, gluten IgE, -lactoglobulin IgE, and α-lactalbumin IgE. Results. AGA-IgG and DPG-IgG titers resulted to be higher in ASDs compared to controls and are only partially influenced by diet regimen. Casein IgG titers resulted to be more frequently and significantly higher in ASDs than in controls. Intestinal permeability was increased in 25.6% of ASDs compared to 2.3% of healthy children. Systemic antibodies production was not influenced by paired/impaired intestinal permeability. Conclusions. Immune system of a subgroup of ASDs is triggered by gluten and casein; this could be related either to AGA, DPG, and Casein IgG elevated production or to impaired intestinal barrier function. Laura de Magistris, Annarita Picardi, Dario Siniscalco, Maria Pia Riccio, Anna Sapone, Rita Cariello, Salvatore Abbadessa, Nicola Medici, Karen M. Lammers, Chiara Schiraldi, Patrizia Iardino, Rosa Marotta, Carlo Tolone, Alessio Fasano, Antonio Pascotto, and Carmela Bravaccio Copyright © 2013 Laura de Magistris et al. All rights reserved. Epidemiology of Back Pain in Children and Youth Aged 10–19 from the Area of the Southeast of Poland Wed, 31 Jul 2013 07:54:11 +0000 http://www.hindawi.com/journals/bmri/2013/506823/ Objective. The aim of this work was to define the prevalence of back pain in children and youth aged 10–19 from the southeast of Poland. Material and Methods. The cross-sectional study included 1089 students (547 girls and 542 boys) aged 10–19. The prevalence of back pain, its intensity, location, and situations in which it occurred were assessed with a questionnaire. Results. Among 1089 respondents, 830 (76.2%) admitted that they had experienced back pain at various frequencies within the year preceding the study. Back pain was located mainly in the lumbar segment (74.8%). Mild pains were dominant, which was declared by 44.7% of the respondents. Girls experienced back pain significantly more frequently than boys (52.2% versus 47.8%, ). Conclusions. The research revealed that back pain is a common phenomenon. The prevalence of back pain in children and youth living in southeast Poland is similar to the frequency of occurrence of such complaints occurring in peers in other countries. It seems significant to monitor the remaining regions of Poland in order to define the scale of the problem and to look for the risk factors of back pain in children and youth to undertake efficient prophylactic actions. Agnieszka Kędra and Dariusz Czaprowski Copyright © 2013 Agnieszka Kędra and Dariusz Czaprowski. All rights reserved. Mechanical Elongation of the Small Intestine: Evaluation of Techniques for Optimal Screw Placement in a Rodent Model Wed, 24 Jul 2013 09:35:57 +0000 http://www.hindawi.com/journals/bmri/2013/601701/ Introduction. The aim of this study was to evaluate techniques and establish an optimal method for mechanical elongation of small intestine (MESI) using screws in a rodent model in order to develop a potential therapy for short bowel syndrome (SBS). Material and Methods. Adult female Sprague Dawley rats () with body weight from 250 to 300 g () were evaluated using 5 different groups in which the basic denominator for the technique involved the fixation of a blind loop of the intestine on the abdominal wall with the placement of a screw in the lumen secured to the abdominal wall. Results. In all groups with accessible screws, the rodents removed the implants despite the use of washers or suits to prevent removal. Subcutaneous placement of the screw combined with antibiotic treatment and dietary modifications was finally successful. In two animals autologous transplantation of the lengthened intestinal segment was successful. Discussion. While the rodent model may provide useful basic information on mechanical intestinal lengthening, further investigations should be performed in larger animals to make use of the translational nature of MESI in human SBS treatment. P. A. Hausbrandt, H. Ainoedhofer, A. K. Saxena, and J. Schalamon Copyright © 2013 P. A. Hausbrandt et al. All rights reserved. Knowledge and Skill Retention of In-Service versus Preservice Nursing Professionals following an Informal Training Program in Pediatric Cardiopulmonary Resuscitation: A Repeated-Measures Quasiexperimental Study Mon, 22 Jul 2013 13:38:05 +0000 http://www.hindawi.com/journals/bmri/2013/403415/ Our objective was to compare the impact of a training program in pediatric cardiopulmonary resuscitation (CPR) on the knowledge and skills of in-service and preservice nurses at prespecified time points. This repeated-measures quasiexperimental study was conducted in the pediatric emergency and ICU of a tertiary care teaching hospital between January and March 2011. We assessed the baseline knowledge and skills of nursing staff (in-service nurses) and final year undergraduate nursing students (preservice nurses) using a validated questionnaire and a skill checklist, respectively. The participants were then trained on pediatric CPR using standard guidelines. The knowledge and skills were reassessed immediately after training and at 6 weeks after training. A total of 74 participants—28 in-service and 46 preservice professionals—were enrolled. At initial assessment, in-service nurses were found to have insignificant higher mean knowledge scores (6.6 versus 5.8, ) while the preservice nurses had significantly higher skill scores (6.5 versus 3.2, ). Immediately after training, the scores improved in both groups. At 6 weeks however, we observed a nonuniform decline in performance in both groups—in-service nurses performing better in knowledge test (10.5 versus 9.1, ) and the preservice nurses performing better in skill test (9.8 versus 7.4, ). Thus, knowledge and skills of in-service and preservice nurses in pediatric CPR improved with training. In comparison to preservice nurses, the in-service nurses seemed to retain knowledge better with time than skills. Jhuma Sankar, Nandini Vijayakanthi, M. Jeeva Sankar, and Nandkishore Dubey Copyright © 2013 Jhuma Sankar et al. All rights reserved. Children with Generalised Joint Hypermobility and Musculoskeletal Complaints: State of the Art on Diagnostics, Clinical Characteristics, and Treatment Mon, 22 Jul 2013 10:43:18 +0000 http://www.hindawi.com/journals/bmri/2013/121054/ Introduction. To provide a state of the art on diagnostics, clinical characteristics, and treatment of paediatric generalised joint hypermobility (GJH) and joint hypermobility syndrome (JHS). Method. A narrative review was performed regarding diagnostics and clinical characteristics. Effectiveness of treatment was evaluated by systematic review. Searches of Medline and Central were performed and included nonsymptomatic and symptomatic forms of GJH (JHS, collagen diseases). Results. In the last decade, scientific research has accumulated on all domains of the ICF. GJH/JHS can be considered as a clinical entity, which can have serious effects during all stages of life. However research regarding the pathological mechanism has resulted in new potential opportunities for treatment. When regarding the effectiveness of current treatments, the search identified 1318 studies, from which three were included (JHS: , Osteogenesis Imperfecta: ). According to the best evidence synthesis, there was strong evidence that enhancing physical fitness is an effective treatment for children with JHS. However this was based on only two studies. Conclusion. Based on the sparsely available knowledge on intervention studies, future longitudinal studies should focus on the effect of physical activity, fitness, and joint stabilisation. In JHS and chronic pain, the effectiveness of a multidisciplinary approach should be investigated. M. C. Scheper, R. H. H. Engelbert, E. A. A. Rameckers, J. Verbunt, L. Remvig, and B. Juul-Kristensen Copyright © 2013 M. C. Scheper et al. All rights reserved. Behavioral Profiles of Clinically Referred Children with Intellectual Giftedness Wed, 10 Jul 2013 13:48:39 +0000 http://www.hindawi.com/journals/bmri/2013/540153/ It is common that intellectually gifted children—that is, children with an IQ ≥ 130—are referred to paediatric or child neuropsychiatry clinics for socio-emotional problems and/or school underachievement or maladjustment. These clinically-referred children with intellectual giftedness are thought to typically display internalizing problems (i.e., self-focused problems reflecting overcontrol of emotion and behavior), and to be more behaviorally impaired when “highly” gifted (IQ ≥ 145) or displaying developmental asynchrony (i.e., a heterogeneous developmental pattern, reflected in a significant verbal-performance discrepancy on IQ tests). We tested all these assumptions in 143 clinically-referred gifted children aged 8 to 12, using Wechsler’s intelligence profile and the Child Behavior Checklist. Compared to a normative sample, gifted children displayed increased behavioral problems in the whole symptomatic range. Internalizing problems did not predominate over externalizing ones (i.e., acted-out problems, reflecting undercontrol of emotion and behavior), revealing a symptomatic nature of behavioral syndromes more severe than expected. “Highly gifted” children did not display more behavioral problems than the “low gifted.” Gifted children with a significant verbal-performance discrepancy displayed more externalizing problems and mixed behavioral syndromes than gifted children without such a discrepancy. These results suggest that developmental asynchrony matters when examining emotional and behavioral problems in gifted children. Fabian Guénolé, Jacqueline Louis, Christian Creveuil, Jean-Marc Baleyte, Claire Montlahuc, Pierre Fourneret, and Olivier Revol Copyright © 2013 Fabian Guénolé et al. All rights reserved. Role of Digoxin-Like Immunoreactive Substance in the Pathogenesis of Transient Tachypnea of Newborn Sun, 07 Jul 2013 16:08:26 +0000 http://www.hindawi.com/journals/bmri/2013/704763/ Background. Transient tachypnea of newborn (TTN) is usually observed in term or near-term infants. It constitutes an important part of the respiratory distress cases observed in the neonatal intensive care unit (NICU). Aim. This paper examines the effects of digoxin-like immunoreactive substance (DLIS) on fluid and ion balance, hemodynamic and echocardiographic parameters of neonates with TTN. Methods. Plasma DLIS, Na+, K+, urea, creatinine, serum and urine osmolarity, urine FeNa+, 24-hour urine output, echocardiographic investigation and mean blood pressure, and clinical parameters of disease severity were recorded in TTN group and compared with control on the 1st and 7th days of their lives. Results. Plasma DLIS levels were statistically higher in TTN group ( ng/mL) compared to control group ( ng/mL) both on the 1st day () and the 7th day (). For TTN group, significant correlation was found between plasma DLIS levels and maximum respiratory rate, duration of tachypnea, and length of hospitalization on the 1st day. Plasma DLIS levels were correlated negatively with serum osmolarity levels. Plasma DLIS levels were positively correlated with urine output, urinary FeNa+ levels, cardiac output, left ventricles end diastolic diameters, and right ventricles end diastolic diameters. Conclusions. Increased DLIS levels were correlated with disease severity in cases with TTN. This increase may be a primary or secondary event in the disease progress. It may help reduce the fluid overload due to already disturbed cardiac functions in patients by increasing urine output and natriuresis; however it may also contribute to disease pathogenesis, by inhibiting alveolar Na+-K+-ATPase which further decreases fetal alveolar fluid resorption. Mehmet Yalaz, Erturk Levent, Murat Olukman, Sebnem Calkavur, Mete Akisu, and Nilgun Kultursay Copyright © 2013 Mehmet Yalaz et al. All rights reserved. MicroRNAs: New Insights into Chronic Childhood Diseases Thu, 27 Jun 2013 10:08:23 +0000 http://www.hindawi.com/journals/bmri/2013/291826/ Chronic diseases are the major cause of morbidity and mortality worldwide and have shown increasing incidence rates among children in the last decades. Chronic illnesses in the pediatric population, even if well managed, affect social, psychological, and physical development and often limit education and active participation and increase the risk for health complications. The significant pediatric morbidity and mortality rates caused by chronic illnesses call for serious efforts toward better understanding of the pathogenesis of these disorders. Recent studies have shown the involvement of microRNAs (miRNAs) in various aspects of major pediatric chronic non-neoplastic diseases. This review focuses on the role of miRNAs in four major pediatric chronic diseases including bronchial asthma, diabetes mellitus, epilepsy and cystic fibrosis. We intend to emphasize the importance of miRNA-based research in combating these major disorders, as we believe this approach will result in novel therapies to aid securing normal development and to prevent disabilities in the pediatric population. Ahmed Omran, Dalia Elimam, and Fei Yin Copyright © 2013 Ahmed Omran et al. All rights reserved. Reduced Cortisol in Boys with Early-Onset Conduct Disorder and Callous-Unemotional Traits Tue, 11 Jun 2013 11:35:37 +0000 http://www.hindawi.com/journals/bmri/2013/349530/ Background. A growing body of evidence suggests an association between altered hypothalamic-pituitary-adrenal axis reactivity and the development of persistent antisocial behavior in children. However the effects of altered cortisol levels remain poorly understood in the complex context of conduct disorder, callous-unemotional (CU) personality traits, and frequent comorbidities, such as attention deficit hyperactivity disorder (ADHD). The aim of the current study was to investigate associations among CU traits, antisocial behavior, and comorbid ADHD symptomatology with cortisol levels in male children and adolescents. Methods. The study included 37 boys with early-onset conduct disorder (EO-CD, mean age 11.9 years) and 38 healthy boys (mean age 12.5 years). Participants were subjected to multiple daytime salivary cortisol measurements and a psychometric characterization. Results. Subjects in the EO-CD group with elevated CU traits showed a diminished cortisol awakening response compared to healthy participants. In the EO-CD group, high CU traits and impulsivity were associated with decreased diurnal cortisol levels, while associations with antisocial behavior were not detected. The cortisol awakening response was significantly inversely associated with hyperactivity () and marginally significant with CU traits (). Conclusions. These results indicate a specific association between CU traits and a diminished stress response, which is not explained by antisocial behavior in general. Georg G. von Polier, Beate Herpertz-Dahlmann, Kerstin Konrad, Kristine Wiesler, Jana Rieke, Monika Heinzel-Gutenbrunner, Christian J. Bachmann, and Timo D. Vloet Copyright © 2013 Georg G. von Polier et al. All rights reserved. Factors Affecting Bilirubin Levels during First 48 Hours of Life in Healthy Infants Thu, 06 Jun 2013 08:36:45 +0000 http://www.hindawi.com/journals/bmri/2013/316430/ Objective. To investigate the relationship of delivery type, maternal anesthesia, feeding modalities, and first feeding and meconium passage times with early bilirubin levels of healthy infants. Methods. Cord, 24 hours’ and 48 hours’ total bilirubin levels were measured in 388 study infants. Results. Infants born with cesarean section were fed later and more often had mixed feeding. First meconium passage was delayed with general anesthesia. Cord, 24 and 48 hours’ bilirubin levels were not correlated with first feeding time, meconium passage time, mode of delivery, existence and type of anesthesia, and feeding modalities. Being in high intermediate risk zone at 72 hours of Bhutani’s nomogram was only related to first feeding time and high cord bilirubin level. Late preterm infants were more frequently born with cesarean section and offered supplementary formula. Therefore, first meconium passage times and bilirubin levels were similar in the late preterm and term infants. Conclusions. Type of delivery or anesthesia, late prematurity, feeding modalities, and first meconium passage time were not related to early bilirubin levels in healthy neonates, but delayed first feeding and high cord bilirubin levels were related to be in higher risk zone for later hyperbilirubinemia. Betul Siyah Bilgin, Ozge Altun Koroglu, Mehmet Yalaz, Semra Karaman, and Nilgun Kultursay Copyright © 2013 Betul Siyah Bilgin et al. All rights reserved.