Epstein-Barr virus infection and its role in the expanding spectrum of human diseases.
Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Japan.
Recent advances of the various laboratory tests to detect Epstein-Barr virus (EBV) infection have clarified the causative role for a spectrum of EBV-associated diseases. They include lymphoproliferative disorders (LPD), which occur in immunologically compromised individuals, Hodgkin's disease (HD), chronic active EBV infection (CAEBV), virus-associated hemophagocytic syndrome (VAHS), certain forms of T cell lymphoma, and some gastric carcinomas, in addition to the classical EBV-associated diseases such as EBV genome-positive Burkitt's lymphoma (BL), undifferentiated nasopharyngeal carcinoma (NPC) and infectious mononucleosis (IM). This review intends to introduce the recent progress of studies on EBV infection mainly from the clinical points of view.
A case of neonatal haemochromatosis.
Oliveira MG. Fernandes A. Silva AC. Moreira R. Azevedo A. Da Silva LJ.
Department of Paediatrics, Hospital Santa Maria, University of Lisbon, Portugal.
We describe a case of neonatal haemochromatosis, pointing out the difficulties in diagnosing this fatal disease, which here involved the early occurrence of hepatic carcinoma.
Measured and predicted bone mineral content in healthy boys and girls aged 6-18 years: adjustment for body size and puberty.
Warner JT. Cowan FJ. Dunstan FD. Evans WD. Webb DK. Gregory JW.
Department of Child Health, University of Wales College of Medicine, Cardiff, UK.
Dual-energy X-ray absorptiometry (DEXA) is a rapid and precise technique for the assessment of bone mineralization in children. Interpretation of the results in growing children is complex as results are influenced by age, body size (height and weight) and puberty. Conventionally, bone mineral data derived from DEXA have been presented as an areal density [BMD; bone mineral content (BMC, g)/projected bone area (BA, cm2)], yet this fails to account for changes in BMC that result from changes in age, body size or pubertal development. Measurement of BMC and BA of the whole body, lumbar spine and left hip were made in 58 healthy boys and girls using DEXA. The relationship between BMC and BA was curvilinear, with the best fit being that of a power model (BMD = BMC/BAlambda, where lambda is the exponent to which BA is raised in order to remove its influence on BMC). The value of lambda changed when measures of body size and puberty were taken into account (e.g. for lumbar spine from 1.66 to 1.49). Predictive formulae for BMC were produced using regression analysis and based on the variables of age, body size and pubertal development. This provides a method for interpreting the measured BMC which is independent of such variables and a constant reference range for children aged 6-18 y.
Rotaviral antibodies in the treatment of acute rotaviral gastroenteritis.
Ylitalo S. Uhari M. Rasi S. Pudas J. Leppaluoto J.
Department of Paediatrics, University of Oulu, Finland.
The efficacy of hyperimmune bovine colostrum received from cows immunized with simian rotavirus SA11 in the treatment of rotavirus gastroenteritis was compared in a randomized double-blind trial to colostrum and ordinary milk preparations. One hundred and thirty-five children aged 6-30 months with rotaviral gastroenteritis received either hyperimmune bovine colostrum (n=42), ordinary colostrum (n=42) or milk (n=41) as a 100 ml solution four times/d for 4 d. Even though the differences were in favour of hyperimmune bovine colostrum in all the variables evaluated [greater weight gain (403 vs 343 g), shorter duration of diarrhoea (3.1 vs 3.6 d), fewer stools during 6 d (11.5 vs 13.6) and fewer stools during the first 3 d (9.3 vs 11.3)], all the differences were statistically insignificant. Differences of this size are clinically unimportant in well-nourished immunocompetent children, but we suggest that the hyperimmune bovine colostrum tested in our trial had some effects in the treatment of acute rotaviral gastroenteritis and should be evaluated further.
Chronic non-specific diarrhoea in childhood: how often is it iatrogenic?
Boehm P. Nassimbeni G. Ventura A.
Department of Clinical Paediatrics, Istituto per l'Infanzia Burlo Garofolo, Trieste, Italy.
Epidemiological data, the appropriateness of the medical approach, the effectiveness of unrestricted diet and the subsequent course of chronic non-specific diarrhoea (CNSD) were evaluated in 20 children, mean age at diagnosis 4.7 y, and mean duration of diarrhoea 24 months. A mean of 2.4 previous hospital admissions and a mean of 2.5 diagnoses other than CNSD were recorded per child before admission. On admission, 14/20 were following an elimination diet and 8/20 had an inadequate caloric intake; 16/20 had a weight/height ratio below the 50th percentile. In all cases a normal diet prescribed during hospitalization improved the diarrhoea and increased weight. A telephone interview performed 5.6 y after discharge revealed that in 10/20 of the cases, the parents were disappointed with the unrestricted diet prescribed during hospitalization. Nevertheless they reported that CNSD stopped spontaneously in a mean time of 1.7 y.
Precipitants and aetiology of cyclic vomiting syndrome.
Withers GD. Silburn SR. Forbes DA.
Princess Margaret Hospital for Children, University of Western Australia, Perth.
Thirty-two patients aged 2-22 y with cyclic vomiting syndrome (CVS), and 64 age- and gender-matched controls were assessed to determine the nature, severity, precipitants and associated features of attacks and the incidence of potential aetiological factors. The mean age of onset was 3.5 y. Patients experienced a mean of nine attacks per year, of average duration 2.4 d, and two-thirds missed more than 10 d of school per year. Patients were more likely to have migraine and co-ordination difficulties, a past history of forceps delivery and gastroesophageal reflux than controls. Compared with controls, subjects had a higher incidence of psychological symptoms (38% compared with 19%) and migraine (37% compared with 9%). CVS is a chronic, disabling condition and is a migraine variant, with attacks usually precipitated by stress and intercurrent infections.
Essential fatty acid metabolism in infants with cholestasis.
Socha P. Koletzko B. Swiatkowska E. Pawlowska J. Stolarczyk A. Socha J.
Kinderpoliklinik, Ludwig-Maximilians University Munich, Germany.
Long-chain polyunsaturated fatty acids are important for the growth and early development of the central nervous system. Cholestatic infants suffer from fat malabsorption and disturbed lipid metabolism and therefore may be at risk of developing polyunsaturated fatty acid depletion. The aims of this study were to determine essential fatty acid status in cholestatic infants and to study the relationship to disease severity, degree of undernutrition, antioxidant status and mode of feeding. Twenty-four-hour dietary records were obtained in 34 cholestatic infants, and measurements were taken of skin fold thicknesses, bilirubin levels, activities of serum alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, prothrombin time, serum concentrations of albumin, bile acids, total lipids, phospholipids, cholesterol, vitamins A and E, the fatty acid composition of plasma phospholipids and plasma lipid peroxides expressed as thiobarbiturate reactive substance (TBARS). Plasma phospholipid fatty acids and TBARS were also determined in 12 age-matched healthy control infants. The cholestatic patients had very low percentage values of phospholipid essential fatty acids, particularly linoleic acid ( 18:2omega-6, median 14.74% vs 20.76% in controls, p < 0.001) and its major metabolite arachidonic acid (20:4omega-6, 6.80 vs 7.87%, p=0.04). The patients' essential fatty acid depletion was reflected by increased levels of the non-essential fatty acids, Mead acid (20:3omega-9, 0.74 vs 0.21%, p < 0.001) and palmitoleic acid (16:1omega-7, 2.20 vs 0.43%, p < 0.001). Polyunsaturated fatty acid profiles did not differ between infants with biliary atresia (n=13) and those with intrahepatic cholestasis (n=21), or between 17 infants with severe malnutrition (all skin folds < 10th percentile) and mild malnutrition (at least two skin folds > 10th percentile). TBARS were significantly higher in cholestatic patients than in controls (2.74 vs 0.85 nmol ml(-1), p < 0.001) and correlated with direct (r=0.41, p=0.02) and total bilirubin. The daily dietary intake of linoleic acid (per 100 kcal) correlated with plasma phospholipid linoleic acid (r=0.38,p=0.037) and total omega-6 fatty acids (r=0.38,p=0.036). Breastfed cholestatic infants (n=6) had higher values of the omega-3 long-chain polyunsaturated fatty acids docosapentanoic acid (22:5omega-3, 0.47 vs 0.28%, p=0.0006) and docosahexanoic acid (22:6omega-3, 2.39 vs 1.73%, p=0.01) than formula-fed infants, while disease severity was similar in the two groups. In conclusion, cholestatic infants are at high risk of essential fatty acid depletion, which appears to be related to fat malabsorption, hepatic essential fatty metabolism, enhanced lipid peroxidation and dietary intake.
Immunogenicity of hepatitis B vaccine in term and preterm infants.
Belloni C. Chirico G. Pistorio A. Orsolini P. Tinelli C. Rondini G.
Division of Neonatal Intensive Care, IRCCS Policlinico San Matteo, Pavia, Italy.
Some studies have suggested that decreased seroconversion rates might be found in premature infants with low birthweight (< 2000g) following administration of hepatitis B vaccine at birth. The aim of the present investigation was to evaluate possible differences in seropositive rates between full-term and preterm infants after primary vaccination, in particular when gestational age or birthweight is very low. Two-thousand and nine neonates born to HBsAg-negative mothers were vaccinated with 10 microg of recombinant hepatitis B virus (HBV) vaccine, from May 1991 to October 1994. Children with infections, congenital malformations or serious illnesses were excluded. HBV vaccine was administered intramuscularly, on the fourth day of life and again at 1 and 6 months of age. A 1-ml blood sample was drawn from each infant 1 month after the third vaccine dose for determination of the level of anti-HBs antibody. The response to HBV vaccination was evaluated in 241 preterm (gestational age
Early detection of necrotizing enterocolitis by gastrointestinal tonometry.
Hatherill M. Tibby SM. Denver L. Marsh MJ. Murdoch IA.
Paediatric Intensive Care Unit, Guy's Hospital, London, UK.
The diagnosis of necrotizing enterocolitis (NEC) in neonates has traditionally depended on a combination of clinical signs, biochemical parameters and radiological changes. The measurement of intramucosal pH by gastrointestinal tonometry provides a simple means of long-term monitoring which may detect the development of NEC before conventional techniques. We present our experience of tonometry in two 'at risk' term neonates with Hypoplastic Left Heart Syndrome.
A review of cystic fibrosis children born to single mothers.
Macpherson C. Redmond AO. Leavy A. McMullan M.
Cystic Fibrosis Regional Unit, Royal Belfast Hospital for Sick Children, Northern Ireland, UK.
The purpose of this study was to examine the relationship between single parents and the health of their children with cystic fibrosis. Seventy-five children aged between 0.8 and 6.0 y were identified from our patient register; 20 of these children came from single parent families. Socioeconomic profiles were collated for each family. Retrospective medical data including, gene mutation analysis, were recorded from the hospital notes of all 75 patients. Maternal health was assessed by means of the General Health Questionnaire (28-item version). The results show that maternal age of < or = 19 y and lone parenthood were associated with higher morbidity in CF patients
Dietary treatment for regurgitation--recommendations from a working party.
Vandenplas Y. Belli D. Cadranel S. Cucchiara S. Dupont C. Heymans H. Polanco I.
Academisch Ziekenhuis Kinderen, Brussels, Belgium.
Regurgitation is a common manifestation in infants below the age of 1 y, and is a frequent reason for counselling of general practitioners and paediatricians. Current recommended therapeutic management starts with parental reassurance and dietary measures, followed by prokinetics. In this paper, the efficacy, safety and nutritional implications of the dietary treatment of regurgitation are evaluated. Industrially prepared thickened feeds may contain cereals of fibres; some have a low lipid content and are casein-predominant. Milk-thickened agents can also be added to regular infant feeding. Formulae claimed as "anti-regurgitation formulae", or positioned as such, should be considered as medical foods or therapeutic diets, and only be available on medical prescription. It is proposed to limit the "anti-regurgitation" (AR) label to those diets which have been proven clinically effective on regurgitation and which are nutritionally safe.
Recurrent Pseudomonas bronchopneumonia and other symptoms as in cystic fibrosis in a child with type I pseudohypoaldosteronism.
Marthinsen L. Kornfalt R. Aili M. Andersson D. Westgren U. Schaedel C.
Department of Paediatrics, Halmstad Hospital, Sweden.
We report a child with multiple target organ pseudohypoaldosteronism type 1 with frequent recurrent pulmonary infections caused by Pseudomonas aeruginosa and Pasteurella multocida and high levels of chloride in sweat, urine and nasal secretion. Repetitive faecal chymotrypsin samples have all shown pathological values in spite of no other sign of exocrine pancreas dysfunction. The similarities with cystic fibrosis and the importance of the salt content in bronchial fluid are discussed.