Arne Stray-Pedersen

Aquaporin-4 gene variation and sudden infant death syndrome.

The purpose of this study was to investigate the aquaporin-4 (AQP4) gene in cases of sudden infant death syndrome (SIDS) and controls and to elucidate the hypothesis that a genetically determined disturbed water homeostasis in the brain is involved as a predisposing factor in SIDS. The single nucleotide polymorphisms (SNPs) rs2075575, rs4800773, rs162004, and rs3763043 in the AQP4 gene were investigated in 141 SIDS cases and 179 controls. For each SIDS case, a brain/body weight ratio was calculated. The study revealed an association between the T allele and the CT/TT genotypes of rs2075575 and SIDS (C versus T, p < 0.01; CC versus CT/TT, p = 0.03). For the other three investigated SNPs, there were no differences in genotype frequencies between SIDS cases and controls. For the SNP rs2075575, it was also found an association between brain/body weight ratio and genotype in the SIDS cases aged 0.3–12 wk (p = 0.014, median ratio CC 10.6, CT/TT 12.1). In conclusion, this study indicates that rs2075575 may be of significance as a predisposing factor for SIDS, and that the CT/TT genotypes are associated with an increased brain/body weight ratio in infants dying from SIDS during the vulnerable period from birth up to 3 mo of age.

Detection rate of Helicobacter pylori stool antigen in newborn infants and small children

Abstract Aims: To investigate the prevalence of H. pylori antigen in the stools of Norwegian neonates and small children. Methods: A total of 249 children aged 0 days–3 years were tested for the presence of H. pylori antigen in feces using the HpSA immunoassay. For verification purposes, a selection of samples were analyzed with PCR targeting the 16 S rDNA Helicobacter gene. Results:H. pylori antigen in stool was detected in 52% (36/69) of the neonates, in 15% (7/46) of infants aged 7 days–1 month, and in 5% (7/134) of children aged 1 month–3 years. In neonates, H. pylori antigen detection was significantly associated with mode of delivery: 59% (30/51) with uncomplicated vaginal births were HpSA positive compared to only 10% (1/10) of infants delivered by cesarean section (P=0.02). Positive PCR results were found in 35% (9/26) of HpSA positive samples. Sequencing of PCR products revealed 97–100% homology with gene sequences from both H. pylori and other Helicobacter species. Conclusions: The low H. pylori antigen detection rate in children >1 month of age is in accordance with previous prevalence studies from Western countries. The unexpected finding of a high H. pylori antigen detection rate in neonates suggests that transient colonization may occur in the neonatal period.

An infant with subdural hematoma and retinal hemorrhages: does von Willebrand disease explain the findings?

An 11-month-old girl presented to hospital with a massive subdural haematoma and bilateral retinal haemorrhages following an allegedly minor fall. There were no external signs of bruising and no prior bleeding tendency was reported. Although initial analyses were normal, repeated testing of the coagulation-fibrinolysis system led to a diagnosis of mild von Willebrand disease (vWD) Type 1. It was concluded that minor head trauma as described by the parents, in the presence of such a coagulation disorder, could explain the findings. Police charges against the parents, initially accused of child abuse, were withdrawn. Retinal haemorrhages in infants with vWD have not been previously reported. This case highlights the importance of considering vWD as a possible contributory factor in cases of infant head injury.

Helicobacter pylori Antigen in Stool Is Associated With SIDS and Sudden Infant Deaths due to Infectious Disease

Infection with Helicobacter pylori has been proposed to be a common cause of Sudden Infant Death Syndrome (SIDS). We investigated the frequency of H. pylori infection in 160 infant deaths and 156 live controls by means of the Helicobacter pylori stool antigen (HpSA) immunoassay. Histology was performed in 26 randomly selected cases. H. pylori antigen was detected in 8% (12/156) of the live controls compared with 25% (30/122) of SIDS cases (p < 0.001), 53% (9/17) of deaths due to infection (p < 0.001), and 9% (1/11) of accidental/violent deaths (p = 0.60). In the classic age peak for SIDS, 1–5 mo, 31% (21/67) of SIDS cases were HpSA positive compared with 1.5% (1/68) of live controls (p < 0.001). Rod-like immunoperoxidase positive H. pylori organisms were identified in 7/12 HpSA positive gastric antrum sections compared with 2/14 HpSA negative (p = 0.038). Significantly elevated IL-6 levels in cerebrospinal fluid representing signs of central immune stimulation were demonstrated in HpSA positive SIDS victims compared with HpSA negative victims (p = 0.045). Detection of H. pylori antigen in stool is associated with SIDS and deaths due to infections. We hypothesize that H. pylori infection in infancy may be involved as the triggering pathogen for sudden death during the first 5 month after birth.

Observational study of child restraining practice on Norwegian high-speed roads: Restraint misuse poses a major threat to child passenger safety

OBJECTIVE Restraint misuse and other occupant safety errors are the major cause of fatal and, severe injuries among child passengers in motor vehicle collisions. The main objectives of the present, study were to provide estimates of restraining practice among children younger than 16 years, traveling on Norwegian high-speed roads, and to uncover the high-risk groups associated with, restraint misuse and other safety errors. METHODS A cross-sectional observational study was performed in conjunction with regular traffic, control posts on high-speed roads. The seating and restraining of child occupants younger than 16, years were observed, the interior environment of the vehicles was examined, and a structured, interview of the driver was conducted according to a specific protocol. RESULTS In total, 1260 child occupants aged 0-15 years were included in the study. Misuse of restraints, was observed in 38% of cases, with this being severe or critical in 24%. The presence of restraint, misuse varied significantly with age (p<0.001), with the frequency being highest among child, occupants in the age group 4-7 years. The most common error in this group was improperly routed, seat belts. The highest frequency of severe and critical errors was observed among child occupants in, the age group 0-3 years. The most common errors were loose or improperly routed harness straps and, incorrect installations of the child restraint system. Moreover, 24% of the children were seated in, vehicles with heavy, unsecured objects in the passenger compartment and/or the trunk that were, likely to move into the compartment upon impact and cause injury. No totally unrestrained children, were observed. CONCLUSIONS This study provides a detailed description of the characteristics of restraint misuse and, the occupants exposure to unsecured objects. Future education and awareness campaigns should, focus on children aged <8 years. The main challenges are to ensure correct routing and tightness of, harness straps and seat belts, correct installation of child restraints, and avoidance of premature, graduation from child restraints to seat belts only. Information campaigns should also advocate the use, of chest clips and address the potential risks of hard, heavy objects in the passenger compartment and, the importance of the placement and strapping of heavy objects in the trunk.

Using the table in the Swedish review on shaken baby syndrome will not help courts deliver justice

1.Department of Forensic Medicine, Section on Forensic Pediatrics, Netherlands Forensic Institute, The Hague, The Netherlands 2.Institute of Legal Medicine/University Hospital of Cologne, Cologne, Germany 3.Department for Pediatric and Adolescent Medicine, Child Protection Center, Klinikum Kassel, Germany 4.Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands 5.Forensic Pathology, University Medical Center, Maastricht, The Netherlands 6.Forensic (Paediatric) Radiology, Amsterdam Medical Center, Amsterdam, The Netherlands 7.Department of Legal Medicine, University Medical Center, Hamburg-Eppendorf, Germany 8.Forensic Pathology and Clinical Forensic Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway

Surfactant protein A and D gene polymorphisms and protein expression in victims of sudden infant death

Aim: To investigate the innate immune components surfactant protein A (SP‐A) and D (SP‐D) in victims of sudden infant death syndrome (SIDS).

Estimation of time since death by vitreous humor hypoxanthine, potassium, and ambient temperature

Measurement of vitreous humor potassium (K(+)) has since the 1960s been recognized as an adjunct for estimation of time since death. In 1991 we introduced hypoxanthine (Hx) as a new marker. Furthermore we demonstrated that time since death estimation was more accurate when ambient temperature was included in the calculations, both for K(+) and for Hx. In this paper we present a refined method. The subjects consist of 132 cases with known time of death and ambient temperature. One sample from each subject was used in the calculations. Vitreous humor Hx levels were available in all subjects, while K(+) was measured in 106 of the subjects, due to insufficient volume of vitreous humor. Linear regression analysis was applied to model the correlation between vitreous humor Hx and K(+), taking the interactions with temperature into consideration. The diagrams published in 1991, which also included ambient temperature, estimated median time since death with range between the 10th and 90th percentile, whereas the linear regression analysis presented in this paper estimates mean time since death with a corresponding 95% interval of confidence. We conclude that time since death may be estimated with relatively high precision applying vitreous humor Hx and K(+) concentrations combined with ambient temperature.

A prospective study of children aged <16 years in motor vehicle collisions in Norway: Severe injuries are observed predominantly in older children and are associated with restraint misuse

OBJECTIVE The implementation of the compulsory wearing of seat belts (SBs) for children and improvements in child restraint systems have reduced the number of deaths and severe injuries among children involved in motor vehicle (MV) collisions (MVCs). Establishing the characteristics predictive of such injuries may provide the basis for targeted safety campaigns and lead to a further reduction in mortality and morbidity among children involved in MVCs. This study performed a multidisciplinary investigation among child occupants involved in MVCs to elucidate injury mechanisms, evaluate the safety measures used and determine the characteristics that are predictive of injury. METHODS A prospective study was conducted of all child occupants aged <16 years involved in severe MVCs in south-eastern Norway during 2009-2013. The exterior and interior of the MVs were investigated and the injured children were medically examined. Supplementary information was obtained from witnesses, the crash victims, police reports, medical records and reconstructions. Each case was reviewed by a multidisciplinary team to assess the mechanism of injury. RESULTS In total, 158 child occupants involved in 100 MVCs were investigated, of which 27 (17%) exhibited Abbreviated Injury Scale (AIS) scores of 2+ injuries and 15 (9%) exhibited AIS 3+ injuries. None of the children died. Of those with AIS 2+ injuries (n=27), 89% (n=24) were involved in frontal impact collisions and 11% (3/27) were involved in side impacts. Multivariate analysis revealed that restraint misuse, age, the prevailing lighting conditions and ΔV were all independently correlated with AIS 2+ injuries. Safety errors were found in 74% (20/27) of those with AIS 2+ injuries and 93% (14/15) of those with AIS 3+ injuries. The most common safety error was misuse of restraints, and in particular loose and/or improperly positioned SBs. CONCLUSION The risk of injury among child occupants is significantly higher when the child occupants are exposed to safety errors within the interior of the vehicle. Future campaigns should focus on the prevention of restraint misuse and unsecured objects in the passenger compartment or boot.

In-Depth Evaluation of Real-World Car Collisions: Fatal and Severe Injuries in Children Are Predominantly Caused by Restraint Errors and Unstrapped Cargo

Objective: Major improvements have taken place in the development of child restraint systems and in-car safety in general, but motor vehicle accidents remain the leading cause of death and disability in children. An interdisciplinary study was therefore performed to investigate the injury mechanisms in car collisions involving children. Methods: Motor vehicle collisions (MVCs) resulting in death or serious injuries to the drivers or their passengers in the southeastern part of Norway in the period 2007–2009 were included in the study if children less than 16 years of age were passengers. An investigation team examined the crash scene within 24 h of the accident. The internal and external environment of the vehicle was investigated, with particular focus on safety equipment and registration of child occupant contact points. Information was collected from witnesses, crash victims, the police, road authority reports, and medical records. Clinical or postmortem examinations were performed on the child occupants. Results: Fifteen high-impact car crashes involving 27 child occupants were investigated: 7 children died (median [range] age 8 (0–15) years), 8 were severely injured (8 [5–13] years), and 12 sustained minor or no injuries (3.5 [0–14] years). Fourteen out of 15 fatalities or severe injuries (MAIS ≥3) were found to be due to various safety errors: harness straps or seat belts incorrectly routed (5/15) or poorly adjusted (4/15), unstrapped luggage (4/15), or technical errors (1/15). All 7 of the fatally injured children died at the crash scene, and 6 died due to head/upper neck trauma. No safety errors were found among the 12 children with either minor or no injuries. No association was found between the instantaneous change in velocity (ΔV) and the injury severity. Conclusion: The risk of child passengers being severely or fatally injured in MVCs is significantly higher when they are incorrectly restrained or exposed to unsecured heavy luggage. Appropriate crash investigations may provide important information regarding the injury mechanisms, which will be necessary for the implementation of preventive measures to reduce future fatalities.