Prenatal exposure to systemic antibacterials and overweight and obesity in Danish schoolchildren: a prevalence study.

BACKGROUND/OBJECTIVE: Prenatal exposure to antibacterials may permanently dysregulate fetal metabolic patterns via epigenetic pathways or by altering maternal microbiota. We examined the association of prenatal exposure to systemic antibacterials with overweight and obesity in schoolchildren. SUBJECTS/METHODS: We conducted a prevalence study among Danish schoolchildren aged 7-16 years using data from routine school anthropometric evaluations conducted during 2002-2013. Prenatal exposure to antibacterials was ascertained by using maternal prescription dispensations and infection-related hospital admissions during pregnancy. We defined overweight and obesity among the children using standard age- and sex-specific cutoffs. We computed sex-specific adjusted prevalence ratios (aPRs) of overweight and obesity associated with exposure to prenatal antibacterials, adjusting for maternal age at delivery, marital status, smoking in pregnancy and multiple gestation; we also stratified the analyses by birth weight. RESULTS: Among 9886 schoolchildren, 3280 (33%) had prenatal exposure to antibacterials. aPRs associated with the exposure were 1.26 (95% confidence interval (CI): 1.10-1.45) for overweight and 1.29 (95% CI: 1.03-1.62) for obesity. Among girls, aPRs were 1.16 (95% CI: 0.95-1.42) for overweight and 1.27 (95% CI: 0.89 to 1.82) for obesity. Among boys, aPRs were 1.37 (95% CI: 1.13-1.66) for overweight and 1.29 (95% CI: 0.96-1.73) for obesity. The aPR for overweight was higher among schoolchildren with birth weight <3500 g (aPR: 1.30, 95% CI: 1.05-1.61) than in schoolchildren with birth weight ⩾3500 g (aPR: 1.18, 95% CI: 0.95-1.46). Inversely, the association for obesity was higher among schoolchildren with birth weight ⩾3500 g (aPR: 1.35, 95% CI: 1.00-1.81) than among those who were <3500 g at birth (aPR: 1.16, 95% CI: 0.82-1.65). CONCLUSIONS: Prenatal exposure to systemic antibacterials is associated with an increased risk of overweight and obesity at school age, and this association varies by birth weight.

Neonatal hypoglycaemia and withdrawal symptoms after exposure in utero to valproate.

AIMS: To define, in a prospective study, the risk of hypoglycaemia-defined as blood glucose concentration < 1.8 mmol/l-in term infants exposed in utero to valproate and to describe the withdrawal symptoms. METHODS: Twenty epileptic women were treated with valproate only during pregnancy and two were treated with valproate and carbamazepine. In the first trimester, the daily median dose of valproate was 1.0 g (range 0.3-4.2) and in the third trimester 1.2 g (range 0.3-4.8). RESULTS: Thirteen of the 22 infants became hypoglycaemic. One infant had eight episodes of hypoglycaemia, one had three episodes, two had two episodes, and nine had one episode each. The lowest blood glucose concentration was 1.0 mmol/l. All episodes were asymptomatic. The maternal mean plasma concentration of total valproate during the third trimester correlated negatively with blood glucose concentration one hour after delivery (p < 0.0003) and with the development of hypoglycaemia (p < 0.0001). There was no evidence for hyperinsulinaemia as the cause of hypoglycaemia. Ten infants developed withdrawal symptoms, which correlated positively with the mean dose of valproate in the third trimester and the concentration of the free fraction of valproate in maternal plasma at delivery (p < 0.02). CONCLUSIONS: Infants exposed to valproate in utero had a significantly elevated risk of hypoglycaemia, and withdrawal symptoms were often observed.

[Dopa-responsive dystonia of childhood]. / Dopa-responsiv dystoni i barndommen.

A case story of dopa-responsive childhood dystonia is presented. The symptoms, diagnostics, pitfalls and treatment are discussed.

[Frequency of unwanted pregnancies among women on waiting lists for sterilization]. / Hyppigheden af uønskede graviditeter blandt kvinder på venteliste til sterilisation.

PIP: Among 763 women who desired sterilization, 67 pregnancies occurred during the waiting period. Among these, 59 induced abortions took place, corresponding to 84.8 induced abortions/1000 women years or 3.4 times the rate in the normal population. It is concluded that women desiring sterilization frequently have problems with contraception and that prolonging the waiting period is of dubious value. (author's modified)^ieng

[Insuject-X for children. A clinical trial of the NPH insulin pen]. / Insuject-X til børn. Klinisk afprøvning af NPH-insulinpen.

The use of Insuject-X for NPH insulin was tested by 21 children, age less than or equal to 10 years with insulin dependent diabetes mellitus less than or equal to 1 year, on conventional treatment with NPH insulin once or twice daily. After a preliminary period of one month the syringe injection regimen was changed to injections by Insuject-X for a four-month "pen" period. We observed no significant changes in metabolic control. The mean potency of NPH insulin in partly used cartridges was 103.6 +/- 5.6 IU/ml (range 91.0-118.1, n = 39) with no correlation to the residual volume or days of use. Measurements over 110 IU/ml were seen at the end of the study indicating the need of repeated instruction in use of the pen by children. No microbial contamination of the cartridges, nor any local reactions at injection sites were found. We observed more technical problems than in adult studies indicating that children handle the pen more roughly. The accept of Insuject-X was good as a more convenient means of injecting. All of the children preferred to continue using it.

[Liver transplantation undertaken on Danes abroad]. / Levertransplantation af danskere i udlandet.

The indication for liver transplantation is the end stage of liver disease. Liver transplantations are not carried out in Denmark at present, one of the reasons being that it requires introduction of the brain death criterion, because the donor liver must be removed during maintained circulation. To date (November 1988), liver transplantations have been carried out abroad on seven Danes. One of these died after operation, one has chronic rejection and is to have retransplantation while the remaining five patients are well. In Europe (including Sweden, Norway and Finland) and USA, more than 5,000 patients have been liver transplanted. The one-year survival is approximately 75%. After this, only few liver-related deaths occur and the majority of patients can resume their previous activities. A total of 18 Danes have been assessed in transplantation centres abroad: Two are waiting for transplantation in the near future and seven have been accepted for transplantation at a later date, depending on the course of the disease. In a number of Danes, liver transplantation has been considered indicated but has not been effectuated because the disease was so advanced at the time of referral, that the patient died before transfer or the patient did not desire operation abroad.

Synovectomy as a prophylactic measure in recurrent haemophilic haemarthrosis. Follow-up of 23 cases.

Because of frequently recurring haemarthrosis which could not be controlled by conservative management 19 haemophiliacs were subjected to synovectomy on a total of 23 joints--17 knees, 5 elbows, and 1 hip. The patients were followed for an average of 23 months. Primary postoperative complications occurred, in the form of recurrent bleeding, in 8 joints. Rehabilitation was often difficult and long-lasting, and the range of joint motion was essentially restricted in 4 cases. After a follow-up period exceeding 6 months the findings in the remaining, mobile 19 synovectomized joints were: 12 had been relieved of haemorrhage, 5 had rare and two frequent haemorrhages. The reduction in the number of haemorrhages was significant (p is less than 0.01). In the light of the complicated postoperative course it is concluded that synovectomy should be used only on strict indications, viz. only in otherwise intractable cases of progressing haemophilic arthropathy.

Hepatitis, type B in haemophiliacs. Relation to the source of clotting factor concentrates.

36 children aged 3 to 18 years receiving substitution therapy for haemophilia during the period 1970 to 1976 were studied for infection with hepatitis B virus by assays for HBsAg, anti-HBs, and anti-HBc. Clinical hepatitis B occurred in 3 patients (8%) and serological evidence of infection was found in further 13 (36%). The occurrence of infection was associated with age but less so with the total amount of transfusion. Estimates of the risk of infection by clotting factor material of different origin indicated a figure of 1:53,000 I.U. for Danish volunteer donor preparations as well as for commercial products, the risk being apparently increased following the use of pooled blood donor material and non-Scandinavian products respectively.

Resection of congenital stenosis of the trachea in an infant.

A case of congenital stenosis of the distal trachea in a 4-week-old boy with severe respiratory distress was treated with circular resection of the trachea. At follow-up, more than one year after operation, the condition of the patient was normal.