Margareta Eriksson

The influence of amphetamine addiction on pregnancy and the newborn infant.

ABSTRACT. influence of amphetamine addiction on pregnancy and the newborn infant has been studied retrospectively in 23 cases. Six of the mothers claimed to have discontinued their abuse in early pregnancy, while the remaining 17 mothers continued throughout. In comparison with the average number of visits by pregnant Swedish women to maternal health centres, the 17 women who continued their abuse made significantly fewer visits, although there was a wide variation. Complications related to pregnancy and delivery were few, however. One child with a myelomeningocele was stillborn. Six children were preterm and three were small for gestational age. Two full‐term children were extremely drowsy and in need of tube feeding, symptoms that might be due to the maternal abuse. Eight of the ten mothers, who had previous children placed in foster homes by the Social Welfare Department, left the hospital with their newborn infant in their care as well as all the eleven primiparae.

Epidemiological Features of Type 22 Echovirus Infection

During a 25-year observation period, isolates of type 22 echovirus were obtained from 109 patients. 92% of the patients were < 2 years old. Echovirus type 22 was isolated with peaks both during late summer and autumn, as enterovirus infections, and during the winter months and early spring, as respiratory viruses. Diarrhea was the most common symptom, followed by obstructive bronchitis and, less often, CNS symptoms. Nosocomial infections were common. In a noticeable number of the children, maternal neutralizing antibodies were most probably present at the time of infection. The epidemiologic features of type 22 echovirus infections with regard to age and seasonal distribution, contagiousness and a relative lack of protection by neutralizing antibodies differed from most enterovirus infections.

Childhood encephalitis in Sweden: etiology, clinical presentation and outcome.

Acute encephalitis is a relatively uncommon but potentially harmful CNS inflammation usually caused by infection. The diagnosis is difficult to establish and the etiology often remains unclear. Furthermore, the long-term prognosis of acute encephalitis in children is poorly described. In this study, we characterize childhood encephalitis from a Swedish perspective in regard to etiology, clinical presentation and sequele. We retrospectively studied all children (n=93) who were admitted for acute encephalitis at Karolinska University Hospital in Stockholm during 2000-2004. A confirmed etiological agent was identified in eight cases and a probable one in 37; in 48 cases no etiological agent could be found. Tick-borne encephalitis virus, enterovirus, respiratory syncytial virus, varicella zoster virus and influenza virus predominated and represented 67% of all the confirmed or probable etiologies. Encephalopathy was present in 80% of the children, 81% had fever, 44% had focal neurological findings, and seizures occurred in 40%. EEG abnormalities were seen in 90% and abnormal neuroimaging was present in 30%. The cerebrospinal fluid showed pleocytosis in 55%. There was no mortality, but 60% of the children had persisting symptoms at the time of discharge, 41% of which were moderate to severe. We conclude that the etiology of encephalitis among Swedish children is at large the same as in other European countries with similar vaccination programs. Fever and encephalopathy were seen in a majority of children and the most sensitive tool for making the diagnosis was EEG examination. Furthermore, many children display persisting sequele at discharge for which the strongest predictive factor was focal neurological findings at presentation.

Echovirus Type 23 Observed as a Nosocomial Infection in Infants

Echovirus type 23 was isolated from 5 children, aged 1-13 months, during a 7-month period, covering a study period of several decades. The children were hospitalized for long periods because of chronic conditions. In 4 cases the virus was isolated from faecal samples, collected because of diarrhoea and/or vomiting. In one case echovirus type 23 was collected from nasopharyngeal secretions from a child with respiratory symptoms. The features of echovirus type 23 infection were similar to those of echovirus type 22, but it is striking that infections with echovirus type 23 were less common during the same decades covered by the study.

Hypervitaminosis a in early human pregnancy and malformations of the central nervous system

Abstract. A case of malformations of the fetal central nervous system following hypervitaminosis A in early pregnancy is reported. The mother was treated with 150000 IU vitamin A daily during gestation days 19 to 40. Determination of urinary oestriol carried out in the 42nd week of pregnancy revealed a very low excretion (4.2‐6.6 μmol/24 h). Induced delivery resulted in a microcephalic child who died after 18 min. The child had multiple malformations of the central nervous system and very small adrenal glands (1.5 g; normal 11±4g). The very low urinary oestriol excretion is well explained by the hypoplastic adrenals, which in turn can be related to insufficient ACTH stimulation, a condition similar to anencephaly. The malformations shown in the present case are considered to be related to the high doses of vitamin A given to the mother, and the authors wish to warn against uncritical use of high doses of vitamin A in women of childbearing age.

Tick-borne encephalitis carries a high risk of incomplete recovery in children.

OBJECTIVE To examine long-term outcome after tick-borne encephalitis (TBE) in children. STUDY DESIGN In this population-based cohort, 55 children with TBE with central nervous system involvement infected during 2004-2008 were evaluated 2-7 years later using the Rivermead post-concussion symptoms questionnaire (n = 42) and the Behavior Rating Inventory of Executive Functioning for parents and teachers (n = 32, n = 22, respectively). General cognitive ability was investigated in a subgroup (n = 20) using the Wechsler Intelligence Scale for Children, 4th edition. RESULTS At long-term follow-up, two-thirds of the children experienced residual problems, the main complaints being cognitive problems, headache, fatigue, and irritability. More than one-third of the children were reported by parents or teachers to have problems with executive functioning on the Behavior Rating Inventory of Executive Functioning, mainly in areas involving initiating and organizing activities and working memory. Children who underwent Wechsler Intelligence Scale for Children, 4th edition testing had a significantly lower working memory index compared with reference norms. CONCLUSION A large proportion of children experience an incomplete recovery after TBE with central nervous system involvement. Cognitive problems in areas of executive function and working memory are the most prevalent. Even if mortality and severe sequelae are low in children after TBE, all children should be followed after TBE to detect cognitive deficits.

Birth weight distribution as an indicator of environmental effects on fetal development

A medical birth registry was used for a geographical analysis of birth weight distribution. Nearly 900 000 Swedish singleton births, 1973–1981, were used for an analysis of the effect of some variables and for standardization for these variables. A marked change in the rate of low birth weight infants (LBW, <2 500 g) was seen in the country between 1976 and 1977. A U-formed effect of maternal age and of parity was demonstrated. A marked interaction between the effects of these two variables existed. Two social groups were compared and the well-known high rate of LBW infants associated with low socioeconomic conditions was demonstrated. Standardization for the variables mentioned influenced this effect only little but reduced the difference between the social groups concerning infants above 3.5 kg weight. The background data were used for analysis of restricted geographical areas.

Salicylate-induced foetal damage during late pregnancy in mice. The modifying effect of repeated administration and dosage.

For many years teratological experiments have been based on the well-known fact that gross malformations can be induced by exogenous factors during organogenesis (2). Thus, the early tests for safety of new drugs were designed in agreement with this fact (27). Attention is now being paid to the vulnerability of the foetus in the perinatal period and special recommendations regarding this point have recently been included in the new guidelines (1 3, 24). There are, however, only a few experimental reports available. Earlier studies from our laboratory have shown salicylate to produce a variety of foetal injuries when administered late in pregnancy (8, 9, 10, 18). There has been increasing interest in perinatal pharmacology during the last decade (7). Experience from investigations of drug metabolism late in pregnancy will be of great value for the design of perinatal drug tests. The present study was undertaken to investigate the role of dosage and the frequency of administration on the prenatal effect produced by salicylate. During this study, special interest was devoted to the possibility of simultaneously influencing drug metabolism and the foetal damaging effect.

IgG and IgM Antibody Responses to Pneumococcal Vaccination in Splenectomized Children and in Children Who Had Non‐Operative Management of Splenic Rupture

ABSTRACT. The IgG and IgM type specific anticapsular pneumococcal antibody titres were studied with ELISA during one year following vaccination with a 14‐valent pneumococcal polysaccharide vaccine in four different patient groups: 41 children splenectomized after a traumatic rupture, 16 splenectomized because of disease, 15 non‐surgically managed after splenic rupture, and 19 healthy controls. Serum samples were obtained before vaccination and after 14, 60, 180, and 360 days. The IgG antibody responses were equally good in all of the patient groups, while the IgM antibody responses were less pronounced in the splenectomized. In the non‐surgically managed patients, the IgM antibody titres after vaccination, as well as antibody responses per se, were significantly higher for all 12 pneumococcal types studied than in the patients who were splenectomized. Both the IgG and the IgM antibody titres were highest at 14 days after vaccination. However, while the IgG titres for most pneumococcal types remained elevated at 360 days, the IgM titres soon fell to prevaccination levels. The antibody response was less good for the types 3 and 6 A. The results indicate that the IgG antibody response to pneumococcal polysaccharide vaccination is unaffected in splenectomized individuals, but the IgM antibody response is decreased. In patients with a healed traumatically damaged spleen, both the IgG and IgM responses seem to be normal.

Review of the aetiology, diagnostics and outcomes of childhood encephalitis from 1970 to 2009

Encephalitis is a rare, serious condition, and antiviral therapies, increased knowledge of inflammatory pathways and improved diagnostics have increased the therapeutic possibilities. We describe 40 years of childhood encephalitis in Sweden, covering the diagnostics, aetiology and outcomes.