Pille Kool

Inflicted traumatic brain injury (ITBI) or shaken baby syndrome (SBS) in Estonia.

BACKGROUND Inflicted traumatic brain injury (ITBI) or shaken baby syndrome (SBS) is recognized as a major cause of disability and death in the paediatric population. AIM To find out the incidence of ITBI in Estonia. METHODS 26 cases of ITBI were recognized: four children died, 22 survived. RESULTS Of 26 children, 20 (77%) were boys and six (23%) were girls. Median age at admission to hospital was 3.9 mo, and the boys were younger than the girls. CONCLUSION The overall incidence of ITBI was 28.7 per 100,000 infants. In the prospective group the incidence was 40.5 per 100,000, and in retrospective group 13.5 per 100,000. ITBI is not rare but not always a recognized form of child abuse. Healthcare professionals should be more aware of this condition.

Elevated plasma adiponectin and decreased plasma homocysteine and asymmetric dimethylarginine in children with type 1 diabetes

Objective. Type 1 diabetes has a bad prognosis concerning the pathogenesis of cardiovascular diseases (CVD). The purpose of this study was to evaluate different possible new risk indices for CVD in children with type 1 diabetes. Material and methods. The present study included 30 children with diabetes (mean HbA1C 9.8%), aged between 4.7 and 18.6 years and with no clinical evidence of vascular complications, and 30 healthy subjects matched by sex, age and body mass index. Blood pressure was measured and blood samples were obtained for lipid profile, creatinine, glucose, high sensitive C‐reactive protein (hsCRP), intercellular adhesion molecule‐1 (ICAM‐1), asymmetric dimethylarginine (ADMA), adiponectin and homocysteine. Results. Children with diabetes had significantly higher blood pressure, plasma hsCRP, ICAM‐1, adiponectin levels and lower homocysteine, ADMA concentrations than their control subjects. In multivariate regression analysis, the best predictors for systolic blood pressure were diabetes group, plasma homocysteine concentration and BMI (Adj R2 = 0.38, p<0.0001), and for diastolic blood pressure diabetes group and triglycerides level (Adj R2 = 0.27, p<0.0001). Conclusions. Children with diabetes, in view of their higher future risk of CVD, are characterized by a higher concentration of protective adiponectin and paradoxically lower blood concentrations of some other possible risk markers of atherosclerosis, i.e. ADMA and homocysteine compared to healthy children.

Increasing incidence of childhood-onset type 1 diabetes mellitus among Estonian children in 1999–2006. Time trend analysis 1983–2006

Teeäär T, Liivak N, Heilman K, Kool P, Šor R, Paal M, Einberg Ü, Tillmann V. Increasing incidence of childhood‐onset type 1 diabetes mellitus among Estonian children in 1999–2006. Time trend analysis 1983–2006.

Factor V Leiden and prothrombin 21210G>A mutation and paediatric ischaemic stroke: a case–control study and two meta‐analyses

Aim:  To determine whether factor V Leiden (FVL) and prothrombin (PT) 20210G>A mutation are associated with paediatric ischaemic stroke.

Iron deficiency and Helicobacter pylori infection in children

Aim:  To examine the relationship between iron deficiency (ID) and Helicobacter pylori infection in school‐aged children.

Magnetic resonance imaging in children with bilateral spastic forms of cerebral palsy.

We analyzed the relationship between magnetic resonance image findings in children with bilateral spastic cerebral palsy and its stages of severity in term and preterm children. Magnetic resonance image findings of 102 children (66 male and 36 female) with bilateral spastic cerebral palsy (median age, 2.5 years; range, 3 months to 15 years) were reevaluated. The study group consisted of children with confirmed perinatal asphyxia. Hypoxic-ischemic events were diagnosed in 64% of the children. Significant abnormalities relevant to cerebral palsy were evident on imaging in 85/102 (83%) children (in 77% of term and 93% of preterm children). Enlargement of the ventricles alone (48%) or accompanied by periventricular white-matter damage (25%) was the most frequent finding in term and preterm children, but was more highly expressed in preterm children (P < 0.05). White-matter damage was more often found in preterm children (P < 0.05). Enlargement of the lateral ventricles and periventricular leukomalacia may be attributable to ischemic damage to the neonatal brain. Significant correlations were found between magnetic resonance image findings and severity of cerebral palsy (P < 0.05). Detection of brain abnormalities in children with cerebral palsy may prove useful in prognoses as well as in medical consultations and management.

Birth weight in newborn infants with different diabetes-associated HLA genotypes in three neighbouring countries: Finland, Estonia and Russian Karelia.

Human leukocyte antigen (HLA) genotypes associated with increased risk for type 1 diabetes mellitus (T1D) have been reported to be associated with increased birth weight. We set out to investigate the association between HLA haplotypes conferring risk for T1D and birth weight and search for possible differences in the strength of these associations among populations with contrasting incidence of T1D.

The reference limits and cut-off value for serum soluble transferrin receptors for diagnosing iron deficiency in infants.

Serum soluble transferrin receptors (sTfR) concentration is a useful test in the diagnosis of childhood iron deficiency (ID). The aims of this study were to establish reference limits and to evaluate the diagnostic characteristics of sTfR in the diagnosis of ID in infants aged 9–12 months. In addition to mean erythrocyte cell volume, haemoglobin and ferritin measurements, sTfR concentration was measured in 179 healthy children in Estonia using the IDeA® and Tina‐quant® methods. Using the ID criteria of ferritin <10 μg/l, subjects were divided into healthy (n = 146) and ID (n = 33) groups. The reference limits (5th and 95th percentile) were calculated in the study group. We used receiver operating characteristic curves to find out the cut‐off values for the best diagnostic characteristics. The reference limits for sTfR were 1.5–2.7 mg/l in the IDeA® method and 4.1–7.8 mg/l in the Tina‐quant® method. The methods had poor agreement, the mean ratio with 95% limits of agreement was 2.9 (2.4–3.6). The best cut‐off value in order to identify ID by hypoferritinaemia in this population is an sTfR level >2.4 mg/l in the IDeA® (sensitivity 84%, specificity 94%) and an sTfR level >7.4 mg/l in the Tina‐quant (sensitivity 80%, specificity 92%). We conclude that sTfR concentration is an efficient tool in the diagnosis of ID, but that every method needs its own cut‐off value.

Early postnatal growth in children with HLA-conferred susceptibility to type 1 diabetes.

An association between increased length/height and weight gain and risk of type 1 diabetes (T1D) has been reported in children. We set out to investigate the potential contribution of T1D human leukocyte antigen (HLA) risk genotypes to this association in two countries with a contrasting disease incidence.

Changes in inflammatory markers in estonian pubertal boys with different BMI values and increments: A 3-Year Follow-Up Study

Serum inflammatory markers could help to identify those boys with overweight (OWB) who gain weight more extensively during puberty. This study aimed to examine the longitudinal changes in different serum inflammatory markers through puberty in boys with different BMI values and increments.