Editorial

Neonatal brain injury is common, essential to appropriate treatment and prevention is a thorough understanding of the pathogenesis. Two articles in this issue of the journal focus on this important topic. Dr. Xanthou analyses the mechanism through which proinflammatory cytokines and chemokines may lead to neuro-degeneration and brain damage. The vunerability of preterm infants to white matter damage, due to immature oligodendrocytes and deficient endogenous protective mechanisms, is described. Therapeutic possibilities of modifying or blocking the activity of proinflammatory cyokines and chemokines in preventing brain damage are discussed. Dr. Torrance and colleagues describe mechanisms of hypoxic ischaemic reperfusion injury and promising pharmacological neuro-protective strategies. In addition, they discuss beneficial effects of early intervention of combination therapy with moderate hypothermia. Dr. Penberthy and colleagues discuss a possible advance in the diagnosis of attention deficit/hyperactivity deficit. Although, neither traditional nor quantitative EEG has revealed persuasive or consistent patterns of EEG abnormalities, they highlight that an advanced quantitative EEG analysis has yielded promising results in small preliminary studies. The impact of preventative measures is reviewed in several articles. Drs. Mann and Lee emphasise that in the UK approximately 28 children die per year from cycle injuries, usually directly attributable to head injuries. They note that helmets reduced the risk of severe brain injury by 74% and also result in reduction in upper and mid facial injuries. This is without a reduction in cycling activity. The case for introduction of legislation in more countries to maximise helmet wearing by young cyclists is emphasised. Nosocomial infections are a major cause of mortality and morbidity particularly amongst vulnerable patients. There are many preventative strategies including health care personnel education and isolation. Dr. Saez-Llorens reminds us that hand washing is the single most effective measure to prevent nosocomial infection. Supine sleeping position has been associated with a reduction in sudden infant death syndrome, but is associated with an increase in referrals for positional or non-synostotic plagiocephaly (NSP). The review highlights that NSP is common and most mild to moderate cases revert to normal by the age of two years. Infants at increased risk are described, including those who are less active, which may explain why developmental delay is sometimes associated with NSP. Many drugs given to children have side-effects. Dr. Schou reviews the role of knemometry in the assessment of growth suppressive effects of glucocorticoid treatment and describes the effects of exogenous glucocorticoids on different components of the lower leg. Epilepsy is a common problem in childhood. Although many efficacious drugs are available, Dr. Verrotti and colleagues remind us that endocrinological side-effects can occur. Two comprehensive reviews of the presentation, investigation and management of clinical conditions are also included. Drs. Polyxeni and Papadopoulou discuss idiopathic hypercalciuria, the most common cause of urolithiasis in children. They highlight that although this complex metabolic disease is considered to be of genetic origin, no specific gene or polymorphisms have been identified. Drs. Barese and Goebel review chronic granulomatous disease (CGD) in childhood. They discuss that current efforts to develop curative therapies include allogeneic bone marrow transplantation for CGD patients with HLA identical sibling donors and transplantation of autologous gene corrected hematopoietic stem cells for patients who lack suitable marrow donors.