Lotta Mellander

Intestinal colonization with enterobacteriaceae in Pakistani and Swedish hospital-delivered infants.

ABSTRACT. Rectal cultures from Swedish and Pakistani hospital‐delivered newborn infants were analysed regarding the early aquisition of enterobacteria. Swedish infants were delivered vaginally, Pakistani infants were delivered either vaginally or by caesarean section. The Swedish infants were all breast‐fed, whereas breastfeeding was incomplete and often started late among the Pakistani infants. Both groups of Pakistani infants were more rapidly colonized with enterobacteria than were the Swedish infants. Cultures from Swedish infants seldom yielded more than one kind of enterobacteria; E. coli and Klebsiefla were most frequently isolated. E. coli dominated in both Pakistani groups, but especially caesarean section delivered infants were in addition often colonized with Proteus, Klebsiella, Enterobacter or Citrobacterspecies. Breastfeeding from the first day of life reduced colonization with Klebsiella/Enterobacter/Citrobucter.The results suggest that environmental exposure, delivery mode and early feeding habits all influence the early intestinal colonization with enterobacteria.

Infant feeding practices in Bhaktapur, Nepal: a cross-sectional, health facility based survey.

BackgroundPromotion of proper breastfeeding practices for the first six months of life is the most cost-effective intervention for reducing childhood morbidity and mortality. However, the adherence to breastfeeding recommendations in many developing countries is not satisfactory. The aims of the study were to determine breastfeeding and infant feeding patterns at nine months of age and to assess factors influencing exclusive breastfeeding practices.MethodsIn Bhaktapur, Nepal, we carried out a cross-sectional survey of 325 infants who came for measles vaccination at the age of nine months. Mothers were interviewed on details regarding feeding of their child and health since birth.ResultsThree quarters of all mothers reported that they did not receive any information on breastfeeding during the antenatal visit. Two hundred and ninety five (91%) mothers gave colostrum and 185 (57%) initiated breastfeeding within one hour of delivery. The prevalence of exclusively breastfeeding at 1, 3 and 6 months were 240 (74%), 78 (24%) and 29 (9%), and partial feeding was initiated in 49 (15%), 124 (38%) and 257 (79%) babies, respectively. The main reason, according to the mother, for introducing other foods before six months of age was insufficient breast milk. In logistic regression analyses, mothers knowledge on how long child should be given only breast milk and not living in joint families were associated positively with exclusive or predominant breastfeeding for four months or beyond.ConclusionsDespite the high proportion of mothers who initiated breastfeeding immediately after birth, continuation of exclusive breastfeeding for up to six months was not common. Very few mothers received any information on breastfeeding during the antenatal visit, indicating a need for counseling on exclusive breastfeeding. Possible options for this counseling could be during antenatal visits and at regular clinic visits for vaccination.

Immune reconstitution after childhood acute lymphoblastic leukemia is most severely affected in the high risk group.

The aim was to examine the immune reconstitution after current chemotherapy for childhood ALL, with a special focus on finding immunologic variables that predict a poor immune response to vaccinations.

Growth in Children Treated for Acute Lymphoblastic Leukemia with and without Prophylactic Cranial Irradiation

ABSTRACT. Growth and weight gain were studied longitudinally over a period of four years in thirty‐nine children treated for acute lymphoblastic leukemia. The children were divided into two groups according to treatment. Twenty‐eight children were given prophylactic cranial irradiation and eleven children were treated without such irradiation. The duration of cytostatic treatment was three years in all cases. Average growth during the first two years was similar in the two groups, and the standard deviation scores (SDS) were below average. The rate of growth (in height) during the fourth year was significantly higher among those children who had not received cranial irradiation (p<0.01). After four years the average attained height had declined 0.5 SD for children treated with cranial irradiation and 0.2 SD for children without such treatment. Weight velocity was significantly greater than the expected mean in the non‐irradiated group during the first year and in the irradiated group during the fourth year of the study. Attained weight after four years had increased 0.4 SD more among those children who had not received irradiation. The results suggest that prophylactic cranial irradiation is responsible for the greater part of the prepubertal growth inhibition in these children.

A longitudinal study on growth and spontaneous growth hormone (GH) secretion in children with irradiated brain tumors

ABSTRACT. Longitudinal growth was studied in 27 children after radiotherapy for a brain tumor. Growth deviation (1 SD) was found in 56% of the children after 2 years and was most profound in prepubertal children aged between 3 and 8 years at the time of irradiation. In this group growth velocity was markedly reduced and no catch up was seen. In all children studied growth hormone (GH) secretion, measured as the spontaneous secretion over 24 hours, was found to be severely disturbed. Our conclusion is that all children with a growth deviation 1 SD after radiotherapy (40 Gy) to the hypothalamo–hypophyseal region should be considered GH deficient. In such children GH treatment can be initiated without further testing.

Immunoglobulin levels and lymphocyte response to mitogenic stimulation in children with malignant disease during treatment and follow-up

Intensification of chemotherapeutic regimens has improved survival in childhood malignant disease. To characterize the impact of this intensified therapy on some aspects of the immune system, we have, in an unselected material of 220 children with malignant disease, investigated serum immunoglobulin levels and lymphocyte response at diagnosis and then subsequently during and up to 4 years after cessation of therapy. In leukemia and Hodgkins disease, all immunoglobulin isotypes decreased during therapy. A profound depression of immunoglobulin M levels, lasting well after completion of therapy, was seen in all tumor types. The mitogenic response was attenuated in patients with leukemia at diagnosis but was rapidly restored after institution of therapy. Patients with solid tumors, particularly Hodgkins disease, had a reduced mitogenic response during therapy. Thus these patients exhibit multiple immunological disturbances. The basis of the pronounced immunoglobulin M deficiency remains unclear.

A comparison of secretory antibodies in breast-fed and formula-fed infants over the first six months of life

In the present study salivary IgA, anti‐Escherichia coli, anti‐β‐lactoglobulin and anti‐poliovirus type 1 IgA and IgM in serum and saliva were evaluated longitudinally in 13 breast‐fed and 14 formula‐fed infants over the first six months of life. Salivary IgA was quantified by electroimmunodiffusion; specific IgA and IgM antibodies were determined in serum and saliva by ELISA. Salivary IgA was significantly lower at age one month in breast‐fed compared with formula‐fed infants but in breast‐fed infants salivary IgA increased with age and was significantly higher at six months than at one month. In both groups of infants, at the age of six months, salivary IgA levels were significantly lower than in adult controls. No significant differences in secretory anti‐E. coli were observed between the two groups of infants. Salivary anti‐poliovirus IgA and IgM antibodies increased transiently only to disappear in most babies at age six months, while anti‐β lactoglobulin IgA and IgM, present in saliva at all ages, showed a wide scatter. No important differences in specific serum IgA or IgM antibodies were observed either between the groups or at different times within the groups.

A Longitudinal Study of Growth in Children with Acute Lymphoblastic Leukemia

ABSTRACT. Growth in terms of both height and weight was studied in a longitudinal sample consisting of ten children who all experienced the onset of acute leukemia between 18 months and 7 years of age. In spite of the lack of deviation in body size at birth, these children had somewhat higher values for attained size than the reference group one year before diagnosis. The information from this study showing a decrease in growth rate before the start of treatment, could suggest that the disease causes the growth failure. Growth rate for height increased with time from the first year of treatment, which could be correlated to a positive effect of medical treatment of the disease. These results indicate a very stable regulation of growth between 18 months and 12 years of age. The children dropped temporarily in mean one standard deviation (SD) corresponding to about 4 cm, from one year before the start of treatment to the end of the three years of treatment. It seems, however, that it is possible for the body to repair such a temporary growth inhibition as is seen in the catch‐up growth during the following two years. Height measured in SD for the group two years after discontinuing treatment was practically the same as height at the time of the start of treatment. Children with leukemia during the first years of life and during the pubertal period may not show a similar growth pattern.

P fimbriae and other adhesins enhance intestinal persistence of Escherichia coli in early infancy

Resident and transient Escherichia coli strains were identified in the rectal flora of 22 Pakistani infants followed from birth to 6 months of age. All strains were tested for O-antigen expression, adhesin specificity (P fimbriae, other mannose-resistant adhesins or type 1 fimbriae) and adherence to the colonic cell line HT-29. Resident strains displayed higher mannose-resistant adherence to HT-29 cells, and expressed P fimbriae (P = 0.0036) as well as other mannose-resistant adhesins (P = 0.012) more often than transient strains. In strains acquired during the first month of life, P fimbriae were 12 times more frequent in resident than in transient strains (P = 0.0006). The O-antigen distribution did not differ between resident and transient strains, and none of the resident P-fimbriated strains belonged to previously recognized uropathogenic clones. The results suggest that adhesins mediating adherence to intestinal epithelial cells, especially P fimbriae, enhance the persistence of E. coli in the large intestine of infants.

Palpable lymph nodes of the neck in Swedish schoolchildren

We studied 3592 Swedish schoolchildren, 8 or 9 years old, examined for palpable submandibular, cervical and supraclavicular lymph nodes. All children were skin tested with 2 TU PPD RT23 and with 0.1 μg of Mycobacterium avium sensitin or 0.1 μg of M. scrofulaceum sensitin. A total of 991 children had palpable lymph nodes in any of the three locations. Among them, 811 had lymph nodes in one location, 162 in two locations and 18 in three. In 312 children, the lymph nodes were ± 5 mm in size in any location. The most common location was submandibular. Boys had a significantly higher prevalence of palpable lymph nodes than girls. There was also seasonal variation. Children infected by atypical mycobacteria (sensitin reaction ±6 mm) did not have a higher prevalence of palpable lymph nodes than those not infected.