bluuebunny/crossref_metadata_2025 huggingface dataset:
Low‐dose inhaled nitric oxide for neonates with pulmonary hypertension
Authors: TANG SF , MILLER OI
Published: March 2008

Objective: Inhaled nitric oxide (iNO) has been shown to cause selective pulmonary vasodilatation and improve ventilation‐perfusion matching and may be an important therapeutic option for the treatment of persistent pulmonary hypertension of the newborn (PPHN). We report our experience on the use of iNO in neonates with severe PPHN.

Methodology: Inhaled NO was administered to 10 infants with PPHN and persistent hypoxaemia (meconium aspiration syndrome, n= 9; pneumonia, n= 1) after failure of conventional therapy to improve oxygenation. With the exception of one infant, iNO was commenced at 10 ppm.

Results: After 30 min exposure to iNO, the arterial oxygen tension (PaO2) rose from a median of 49 mmHg (6.5 kPa) [range 12‐82 mmHg (1.6‐10.9 kPa)] to 75 mmHg (10 kPa) [range 17‐450 mmHg (2.3‐60 kPa)] (P= 0.005), while the median oxygenation index fell (pre‐iNO of 37 vs post‐iNO 20) (P= 0.005) and median systemic arterial pressure rose (pre‐iNO 46.5 mmHg (6.2 kPa) [range 32‐63 mmHg (4.3 to 8.4 kPa vs post‐iNO 54.5 mmHg (7.3 kPa) [range 36‐74 kPa]) P= 0.005). All infants subsequently continued to receive iNO with the duration of exposure to iNO ranging from 12 to 168 h (median duration 100 h). Three infants died despite showing an initial beneficial response to iNO. The mean duration of intubation for survivors was 11.9 ± 2.6 days. Methaemoglobinaemia and toxic levels of nitrogen dioxide were not seen during iNO administration. Of the seven survivors, 12 month follow up in two infants and 4 month follow up in four infants showed age‐appropriate neurodevelopmental skills, with one infant having very mild hearing loss.

Conclusions: Inhaled NO reduces the oxygenation index by improving the PaO2 and decreasing ventilation pressures, and appears to be clinically useful in severely hypoxaemic infants with PPHN refractory to conventional treatment.
Stress responses in preterm neonates after normal and at‐risk pregnancies
Authors: VAN REEMPTS PJ , WOUTERS A , DE COCK W , VAN ACKER KJ
Published: March 2008

Objective: To evaluate the autonomic response in preterm neonates born after an at‐risk pregnancy.

Methodology: Twenty‐one preterm neonates (gestational age; GA) 29‐37 weeks; bodyweight (BW): 720‐2113 g; postnatal age: 2‐126 days), born after at‐risk pregnancies (stressed (STR) group), were compared to 30 preterm neonates (GA: 26‐36 weeks; BW: 813‐2380 g; postnatal age: 2‐86 days) without any intrauterine risk factor (C group). A 10s pain stimulus was given on the forefoot and heart rate, respiratory rate and blood pressure were measured at 15 and 30 s, at 1, 2, 3, 4 and 5 min. After 10 s ocular compression six cardiac variables were recorded.

Results: After the pain stimulus the STR‐group had a significant increase of heart rate at 15 s and an increase of diastolic blood pressure at 30 s. In the C group a significant increase of heart rate at 15 s was recorded. For the respiratory rate both groups showed an initial depression (significant at 15 s in the C group) followed by an increase. The time to react to the ocular compression was significantly shorter in the STR‐group than in the C‐group and thus more parasympathetic.

Conclusions: We hypothesize that the different sympathetic and parasympathetic reaction patterns of the vital parameters to triggers in the STR‐group are due to chronic stress, pointing to an altered maturation of the two components of the autonomic nervous system after chronic intrauterine stress (CIUSTR).
Strategies to prevent chronic neonatal lung disease
Authors: SCHINDLER MB
Published: March 2008

ABSTRACT The pathogenesis of chronic neonatal lung disease involves the combined iatrogenic insults of oxygen toxicity and barotrauma in addition to lung inflammation. Newer ventilator strategies using smaller tidal volumes (3–7 mL/kg) in order to avoid overdistension, higher positive end‐respiratory pressure and lower peak inspiratory pressures decrease barotrauma. Earlier reduction of FiO2 through the use of surfactant, high frequency ventilation and nitric oxide reduce oxygen toxicity. Other measures include careful fluid balance, avoidance of prolonged paralysis and early steroids to decrease inflammation.
New developments in the management of violent children and adolescents
Authors: SMITH CA
Published: March 2008

ABSTRACT Paediatricians are often asked to see children and adolescents with behavioural disorders which include an element of violence directed at peers, family members or teachers. Inevitably this group of children poses a considerable management challenge, irrespective of the multiple aetiological contributions to the behaviours. This paper renews some of the evidence for a neurophysiological contribution to violent behaviour, provides a rationale for pharmalogical treatment and outlines a suggested management plan based on extensive clinical experience. The results of this regimen have been highly successful. This regimen is inexpensive, successful and empowers both patient and family through the development of positive interpersonal interactions.
Chest radiograph abnormalities in very low birthweight survivors of chronic neonatal lung disease
Authors: FITZGERALD DA , ASPEREN PP VAN , LAM AH , SILVA M DE , HENDERSON‐SMART DJ
Published: March 2008

Objective: To determine whether the neonatal chest radiograph (CXR) at 28 days in very low birthweight (VLBW) infants who develop chronic neonatal lung disease (CNLD) predicts oxygen therapy duration or CXR abnormalities in early childhood. Also, to assess the inter‐observer reliability of the radiologists scoring the CXR.

Methodology: Clinically well survivors of CNLD (n= 46) had neonatal CXR scored (mean age 28.5 days) and compared with current CXR (mean age 40 months). The CXR were scored independently and ‘blindly’ by two paediatric radiologists using a standardized scoring system (range 0‐10).

Results: There was no correlation between neonatal CXR scores and current CXR scores for either radiologist. There was no association between CXR severity scores and duration of oxygen therapy for either neonatal or current CXR. Radiologist A scored the current CXR significantly more abnormal than radiologist B [medians (range): 3 (1‐6) vs 1 (0‐5), P <0.001] with reasonable correlation (r= 0.593, P <0.005) but worse than chance agreement (kappa = ‐ 0.034). The median scores for the neonatal CXR were similar [1.5 (0‐8) vs 2 (0‐8), P= 0.789] and again there was good correlation (r= 0.760, P <0.0005) although poor individual agreement (kappa = 0.243) between radiologists.

Conclusions: Follow‐up CXR abnormalities in VLBW infants with CNLD are usually minor and are not predictive of the duration of oxygen therapy that will be required nor of the CXR appearance in early childhood. Considerable inter‐observer variation exists in the interpretation of the CXR in CNLD.
Measuring health outcome in paediatrics: Development of the RAHC measure of function
Authors: DOSSETOR DR , LIDDLE JLM , MELLIS CM
Published: March 2008

Objective: To develop a generic measure of health outcome (the RAHC Measure of Function) for paediatric health services.

Methodology: The RAHC Measure of Function (MOF) was modified from the Child Global Assessment Scale. The utility and reliability of the MOF was then tested by inter‐clinician agreement on case scenarios, by inter‐clinician agreement in outpatients, by parent‐clinician agreement in outpatients and by responsiveness to change in acute admissions.

Results: The inter‐clinician agreement on MOF ratings for case scenarios was moderately good, with an overall kappa of 0.42; P <0.0001. Clinicians at respiratory and child psychiatry clinics nominated the same or adjacent MOF category to describe 100% (95% Cl: 71.5‐100) and 90% (95% Cl: 68.3‐98.8%) of 11 and 20 cases assessed, respectively. Parents nominated the same or adjacent MOF category as the attending clinician for 89.7% (95% Cl: 72.7‐97.8) and 82.9% (95% Cl: 67.9‐92.9) of 29 and 41 children in the same two clinics. Twenty‐eight inpatient children had an MOF assessed on admission and discharge, and the median MOF score improved from 50.5 to 79 points (z= 4.53; P <0.0001).

Conclusions: The MOF is easy to use and provides a valuable description of health outcome that parents are able to understand. The MOF is moderately reliable, is likely to be sufficiently reliable to compare groups of paediatric patients and is responsive to change.
Mutations, malformations and mortality
Authors: SUTHERS G
Published: March 2008

Although DNA replication is a very accurate process, a small number of new mutations are generated at every cell division. The generation of a new mutation during the formation of an ovum or sperm cell can cause an early miscarriage or birth defect The generation of new mutations during embryogenesis can cause a variety of localized birth defects. The molecular delineation of these errors in somatic and gonadal cells has clarified the basis of some birth defects, and has both refined and complicated genetic counselling for a number of paediatric conditions. The processes responsible for these new mutations are present in all cells. For this reason new mutations accumulate in all cells throughout life and contribute to the ageing process. Thus the molecular events that cause many miscarriages and birth defects are the same as those that ultimately lead to death.
Oral rehydration solutions in gastroenteritis before and after admission to hospital
Authors: BARNES GL
Published: March 2008

Two recent studies published in this Journal draw attention to deficiencies in treatment of children with acute infectious diarrhoea in Australia.1,2 There is now no doubt that use of correctly constituted oral rehydration solutions provides optimal therapy for affected children unless circulation is compromised, vomiting is more than average, or complicating disorders are present. In the vast majority of cases, these complications do not occur. A high proportion of the childhood population experiences gastroenteritis at some time. It is known that 50% of Melbourne children require medical attention for rotavirus infection alone during their first 3 years of life, although less than 5% require admission.
Pre‐admission management of acute gastroenteritis
Authors: ELLIOTT EJ , BACKHOUSE JA , LEACH JW
Published: March 2008

Objective: Acute gastroenteritis contributes to significant morbidity and need for hospital admission. The current literature suggests outpatient management is often inappropriate. This study examines the pre‐admission management of children admitted with acute gastroenteritis to a major children's hospital.

Methodology: Information was obtained from parental questionnaires and the medical notes for 164 children.

Results: Parents were poorly informed regarding appropriate home management Over 70% sought professional advice prior to admission, usually from their general practitioner. Although 58% received advice on fluid therapy, an oral rehydration solution was recommended for only 32%. and only 9% actually used one before admission. Advice regarding fluid requirements was usually inadequate. Inappropriate medications were prescribed for 22% of children, including antibiotics (15.4%). antidiarrhoeals (1.2%) and anti‐emetics (5.5%). Hospitalized children were generally well nourished with minimal dehydration and electrolyte disturbance.

Conclusions: Oral rehydration therapy is utilized rarely and medications are over‐utilized in home management of gastroenteritis. Education of parents, general practitioners and hospital doctors is essential to optimize outpatient management The impact of optimal outpatient management on hospital admission rates and morbidity requires formal assessment.
Predictive value of the Griffiths assessment in extremely low birthweight infants
Authors: BOWEN JR , GIBSON FL , LESLIE Gl , ARNOLD JD , MA PJ , STARTE DR
Published: March 2008

Objective: To assess the relationship between the Griffiths Mental Development Scales at 1 and 3 years and the Stanford‐Binet Intelligence Scale (S‐B) and Beery Test of Visual‐Motor Integration (VMI) at 5 years in extremely low birthweight (ELBW) children.

Methodology: Prospective study of 45 ELBW infants, without severe neurosensory impairment, cared for in a single Level III neonatal intensive care unit.

Results: At 5 years, 36 (80%) children were of average intelligence, 8 (18%) had borderline intelligence and one was mentally retarded. The Griffiths general quotient (GQ) at 1 year had a weak correlation with the S year IQ (corr. coeff. = 0.47), with only 17% of children with a GQ< — 1 s.d. at 1 year receiving an IQ< — 1s.d. at 5 years. In contrast, the Griffiths GQ at 3 years correlated strongly with 5 year IQ (corr. coeff. = 0.78). Among those children with a 3 year GQ< — 1s.d., 67% had a 5 year IQ< — 1 s.d. and all had a 5 year IQ<89. The 3 year hearing and speech subscale correlated strongly with the 5 year S‐B verbal comprehension factor (corr. coeff = 0.753) and the 3 year combined eye/hand co‐ordination/performance quotient had a moderate correlation with the S‐B non‐verbal reasoning factor (corr coeff = 0.597) and with the Beery VMI (corr coeff = 0.49).

Conclusions: The 3 year Griffiths GQ is a good predictor of 5 year S‐B IQ in ELBW children and can be used to identify children who may benefit from intervention prior to school entry.
Rollerblading injuries in young people
Authors: HELLER DR , ROUTLEY V , CHAMBERS S
Published: March 2008

Objective: To study injuries In young people associated with the use of rollerblades, draw comparisons with skateboarding and rollerskating injuries, and suggest strategies for injury prevention.

Methodology: Injuries associated with the use of rollerblades, skateboards and rollerskates in young people aged 14 years recorded on the Victorian Injury Surveillance System database since its inception in 1989 were examined to identify secular trends. All injuries associated with these pastimes recorded on the database by three sentinel hospitals during a 1 year period were examined in detail. Medical notes were perused to verify features of the event and obtain further information. A semi‐structured telephone interview of a sample of 10‐14 year old rollerbladers, the most commonly injured age‐group, was carried out to obtain more specific information.

Results: There has been a marked increase in the absolute numbers of injuries associated with the use of rollerblades since 1989. In 1992, they were most common in the 10‐14 year age group, which sustained 59% of all injuries; 47% of injuries were fractures of the forearm and wrist. Of a sample of 33 of those injured in the 10‐14 year age group, 10 (30%) had been using rollerblades for the first time. There is some evidence to suggest a concomitant fall in skateboarding injuries.

Conclusions: Injury surveillance data collected in Melbourne suggest an increasingly important contribution by rollerblading to the pattern of injury seen in young people. Preventive strategies require further evaluation but could include learning basic techniques in a controlled setting, separation from road traffic and the wearing of helmets and wrist, elbow and knee guards.
Does the amniotic fluid protein absorption contribute significantly to the fetal weight?
Authors: CHENG W , MYA GH , SAING H
Published: March 2008

Objective: This study was carried out to evaluate the significance of amniotic fluid protein ingestion and absorption on fetal growth.

Methodology: Neonates with small bowel atresia during a 30 year period were studied retrospectively.

Results: There were 56 patients enlisted, 17 with duodenal atresia, 18 with jejunal atresia and 21 with ileal atresia. The percentage of mothers with polyhydramnios and the percentage of premature babies decreases as the intestinal atresia becomes more distal. The mean gestational age and the mean birthweight increase as the intestinal atresia becomes more distal. On the other hand, the percentage of the neonates with birthweight below the 50th and the 10th percentiles do not differ significantly as the intestinal atresia becomes more distal.

Conclusions: It appears that the variation of birthweights in babies with different levels of small bowel atresia may be due to the difference in gestation caused by polyhydramnios. The effect of amniotic fluid protein absorption on fetal bodyweight could not be demonstrated clinically in this study.
Stress and work relationships in the neonatal intensive care unit: Are they worse than in the wards?
Authors: OATES PR , OATES RK
Published: March 2008

Objective: To compare working conditions, sources of stress and professional relationships between a group of nurses working in neonatal intensive care units (ICU) and those working in general paediatric teaching hospital wards.

Methodology: Surveys were sent to 96 nurses working in general paediatric wards in three Sydney paediatric teaching hospital centres and to 291 nurses working in six major neonatal ICU in Sydney. The survey asked about work environment, patient care, decision‐making, sources of stress and professional relationships. Thirty‐one questions were identical in each survey. The survey also included the General Health Questionnaire (GHQ) as a measure of emotional health.

Results: The response rate was ward nurses 86% and neonatal intensive care nurses 66%. Of the 31 identical statements, nine were significantly different between the two groups. Neonatal nurses were more likely to feel that their ward work areas were overcrowded and poorly laid out with little patient‐free space. They had more concerns about inadequate staffing and conflict between nurses and doctors. The general ward nurses were more likely to feel that adequate priority was given to patient pain relief and that they had more influence in such decisions but experienced more stress in keeping up to date and were more likely to feel that communication problems between doctors and nurses were a major source of conflict. Forty per cent of general ward nurses and 32% of neonatal nurses had GHQ scores indicating possible psychological impairment, a significantly higher proportion than would be expected in the population.

Conclusions: Paediatric nurses perceive a variety of stresses in their work, with problems in communication between doctors and nurses being a prominent perception. The high GHQ scores may be a reflection of some of those problems. Attention to problems of under‐staffing, better work environment and improved communication may help resolve some of these issues and may have implications for improving patient care.
Increased serum creatinine associated with severe primary hypothyroidism
Authors: HALL C , BATCH J , JONES C
Published: March 2008

A case of myxoedema due to Hashimoto's thyroiditis associated with a significant increase in serum creatinine is reported. Thyroid hormone replacement therapy resulted in normalization of the serum biochemistry within 1 month.
Attention deficit hyperactivity disorder: Perceptions, practice and politics
Authors: MELLOR DJ , STORER SP , BROWN J
Published: March 2008

Abstract: Some of the issues related to the doubts and complexities involved in the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) are reviewed. While some writers claim that it is clear that all children presenting with ADHD should be treated by pharmacological means, there are associated risks and politics. However, in the absence of well established and research‐supported alternative understandings of the aetiology and treatment of the disorder, many practitioners feel unable to offer a useful service. Resulting frustrations have led some parents to form their own support networks, which make strong demands for increased services. More creative and innovative therapeutic interventions focusing on the broader impact of ADHD must be developed to deal with this disorder.
National trends in the use of stimulant medication for attention deficit hyperactivity disorder
Authors: VALENTINE J , ZUBRICK S , SLY P
Published: March 2008

Objective: To document the use of stimulant medication in the diffent states and territories of Australia in 1993 and trends in use of stimulant medication in Western Australia and New South Wales from 1988 to 1993.

Methodology: Health authorities in the states and territories of Australia were contacted and requested to provided data on total numbers, patient gender, date of birth, postcode and type of stimulant medication prescribed to estimate the prevalence of use of stimulant medication in Australia

Results: Despite variation in the data obtained from each health authority there is a significant difference in the rates of use of stimulant medication between states and territories in Australia, and a significant increase in use between 1988 and 1993 in Western Australia and New South Wales.

Conclusions: These trends should continue to be closely monitored and the possibilty of establishing national prescription guidelines considered.
Neonatal subgaleal haematoma: Associated risk factors, complications and outcome
Authors: CHADWICK LM , PEMBERTON PJ , KURINCZUK JJ
Published: March 2008

Objective: To describe the obstetric and perinatal factors, in particular the method of delivery, associated with development of a subgaleal haematoma (SGH) and to determine the outcome of survivors with this type of birth trauma.

Methodology: Perinatal and obstetric data were retrospectively reviewed for 37 infants admitted to the neonatal unit of the sole tertiary paediatric referral hospital in Western Australia with an SGH, over a 24 year period from 1970 to 1993. These data were compared to data for all Western Australian births. The long‐term outcome was obtained through medical and private paediatric records for 26 of these infants.

Results: All except one of the neonates had instrumental deliveries; 89% had a vacuum extractor applied to the head at some stage of delivery compared to 10% of the general population of births in Western Australia. There was also a significantly increased risk of failure of attempted vacuum extraction. Of the cases where a vacuum extraction was attempted, 45% also had forceps applied to the head. Coagulopathy was associated with the severity of the SGH. There was also a high frequency of occurrence (40%) of associated head trauma such as intracranial haemorrhage, skull fracture and cerebral oedema, as well as neonatal encephalopathy (73%). The occurrence of these associated features did not correlate significantly with the severity of SGH. Minor complications of SGH included jaundice and facial bruising.

There was an excess mortality associated with SGH; however, the long‐term outcome for neonatal survivors with this disorder was good. None of the cases studied subsequently developed cerebral palsy or intellectual disability, and minor neurological sequelae only were documented in four infants.

Conclusions: SGH is an uncommon type of birth trauma, and is associated with delivery or attempted delivery by vacuum extraction. The most commonly associated clinical problems were hypovolaemia and coagulopathy. The long‐term outcome for neonates with this condition is good.
A new breast milk supplement for preterm infants
Authors: SIMMER K
Published: March 2008

Objective: To assess the effect of a new formula (Prenan), which contains n‐3 and n‐6 long‐chain polyunsaturated fatty acids (LC PUFA) on the fatty acid profile of preterm infants.

Methodology: Plasma fatty acids were measured in 61 preterm infants at term by gas liquid chromatography. In 20 of these infants, paired samples were collected and changes in fatty acids with time analysed.

Results: Plasma docosahexaenoic acid (DHA) levels were higher in those who had been fed expressed breast milk (EBM) ±/or Prenan compared with those fed standard formula ± EBM, P<0.05. The plasma arachidonic acid (AA) levels of infants fed Prenan were not different to those fed EBM, both groups achieving higher levels than infants fed standard formula, P<0.05. Further, paired analysis demonstrated that DHA levels increased in infants changed from standard formula to Prenan to levels equal or higher than those of fully breast‐fed infants (P<0.01), whereas DHA levels remained unchanged with time in all other groups.

Conclusions: The fatty acid composition of Prenan enables preterm infants fed formula to have plasma DHA and AA levels similar to those of infants fed breast milk and consequently different to those of infants fed standard formula. Prenan is an appropriate supplement to breast milk for preterm infants in that it provides LC PUFA as well as additional phosphorus and protein without exposing the infant to intact cows milk protein.
Factors affecting the neonatal response to artificial surfactant
Authors: SKELTON R , JEFFERY HE
Published: March 2008

Objective: To define the individual neonatal response to the artificial surfactant, Exosurf, and factors that may influence the response.

Methodology: Eighty‐two consecutive, preterm neonates with respiratory distress syndrome, who received Exosurf at <12h of age were studied. Their response was categorized from the graphical change in the oxygenation index with postnatal age, for 12h after each of two doses of surfactant and assessed independently by two observers. Clinical factors were analysed for their effect on the four pre‐defined categories of response, namely: none; mild; good; relapsed; and good: sustained.

Results: Within the first 12h, 11% of the neonates showed no response, 5% a mild response and 84% a good response, but 34% relapsed. By 24h, 6% still showed no response (all died), 11% showed a mild response and 83% a good response, of whom half relapsed. At 24h, no response was significantly associated with low gestational age and asphyxia mild response with less severe lung disease. According to the response there was a gradation in the risk of death during the first week.

Conclusions: The response to Exosurf can be individually and reproducibly categorized and demonstrated that 83% of neonates had a good response but half relapsed. No response was associated with extreme prematurity and asphyxia
Combined pharmacotherapy or polypharmacy?
Authors: LEVY F , EINFELD S , LOOI J
Published: March 2008

Abstract: A case of possible ‘serotonin syndrome’is reported. The use of combinations of psychotropic medications to treat children with severe behaviour disorders is an increasing trend among paediatricians and child psychiatrists. Some hazards as well as possible advantages are discussed.
Late onset haemorrhagic disease in premature infants who received intravenous vitamin K1
Authors: LOUGHNAN PM , McDOUGALL PN , BALVIN H , DOYLE LW , SMITH AL
Published: March 2008

Abstract: The clinical details are reported of two premature infants who developed late onset haemorrhagic disease after receiving their initial doses of vitamin K1 prophylaxis intravenously. Both reported infants had received two doses of intravenous vitamin K1, 0.1 mg, in the 1st week of life, and a further oral dose, 1.0 mg, at 4 weeks. Bleeding due to vitamin K deficiency occurred on days 74 and 84, respectively. Vitamin K deficiency bleeding is rare in low birthweight infants, probably because it has been routine practice to give such infants intramuscular vitamin K1. One of the reported infants had cytomegalovirus hepatitis, the other did not have liver disease. These findings could be explained if intramuscular vitamin K1 were to have a longer duration of effect than intravenous vitamin K1. This may be because intramuscular vitamin K1 acts as a depot preparation. The findings suggest that intravenous vitamin K1 is less effective than intramuscular for long‐term prophylaxis against late onset haemorrhagic disease. Intravenous vitamin K1 should not be used for long‐term prophylaxis in the prevention of late onset haemorrhagic disease.
Symptoms, sweating and reactivity of infants who die of SIDS compared with community controls
Authors: TAYLOR BJ , WILLIAMS SM , MITCHELL EA , FORD RPK ,   THE NEW ZEALAND NATIONAL COT DEATH STUDY GROUP
Published: March 2008

Objective: To describe the symptoms of illness reported by the parents of infants who have died of sudden infant death syndrome (SIDS) compared with those reported by community controls.

Methodology: A nationwide case—control study involving regions of New Zealand with 78% of all births between 1987 and 1990. Home interviews were completed with parents of 393 (81% of total) infants who died from SIDS in the post neonatal age group, and 1592 (88.4% of total) controls who were a representative sample of all hospital births in the study region.

Results: Symptoms of infection were common in both cases and controls, but were not significantly different. Infants dying of SIDS, however, were likely to have symptoms suggestive of more severe illness in the 2 days before death (odds ratio [OR] = 3.02, 95% confidence interval [CI] 1.69‐5.38). After adjusting for potential confounding this was still statistically significant (adjusted OR 2.36, 95% Cl 1.14‐4.90). Also, babies dying of SIDS were more likely to have been less reactive to their environment in the 2 weeks before death compared with the controls (univariate OR 0.88, 95% Cl 0.55‐1.39, adjusted OR 0.55, 95% Cl 0.59‐0.88).

‘Drenching’ sweats at least weekly were reported for 15.6% of case infants compared with 5.9% of control infants (adjusted OR 2.12, 95% Cl 1.53‐3.39). Forty per cent of these infants had this symptom in the first 4 weeks of life when it was also associated with a significantly raised risk of SIDS. Apnoea lasting more than 20 s was reported for 13.2% of case infants compared with 5.3% of control infants (adjusted OR 1.93, 95% Cl 1.17‐3.17). Similarly, 71.8% of case infants' faces were reported to never turn red while awake compared to 49.8% of control infants (adjusted OR 2.98, 95% Cl 2.19‐4.07).

Conclusions: Only a small number (6.4%) of babies who die of SIDS have symptoms of serious illness in the 2 days before death. There is support for the hypothesis that there is a group of babies dying of SIDS who have subtle abnormalities in autonomic control or arousal ability.
Bronchopulmonary dysplasia and very low birthweight: Lung function at 11 years of age
Authors: DOYLE LW , FORD GW , OLINSKY A. , KNOCHES AML , CALLANAN C.
Published: March 2008

Objective: To determine the relationship between lung function at 11 years of age and bronchopulmonary dysplasia (BPD) in very low birthweight (VLBW) children.

Methodology: This study comprised 154 consecutive surviving VLBW children, divided into three groups with respect to their neonatal respiratory morbidity: group I developed BPD; group II required assisted ventilation but did not develop BPD; and group III required no assisted ventilation. Lung function tests were measured on 120/154 (77.9%) children at 11 years of age. The relationship between various lung function variables and neonatal lung disease was analysed by multiple linear regression.

Results: Several lung function variables reflecting airflow were significantly diminished in the BPD group (n= 15), and residual volume was significantly higher. Despite poorer lung function overall, few children in the BPD group had lung function abnormalities in the clinically significant range (n= 2 [13.3%] with a forced expired volume in 1 s <75% predicted; n= 2 [13.3%] with a forced vital capacity <75% predicted; n= 1 [6.7%] with a residual volume/total lung capacity >35%). There were no significant differences in lung function variables between group II (n= 41) and group III (n= 64). Changes in lung function tests between 8 and 11 years did not vary significantly between the three groups.

Conclusions: VLBW children with BPD in the newborn period have poorer lung function at 11 years of age than other surviving VLBW children without BPD, although few have lung function abnormalities in the clinically significant range.
Paediatric urolithiasis in a remote Australian Aboriginal community
Authors: WILLIAMS WM , NICHOLAS JJ , NUNGURRAYI PB , NAPURRULA CR
Published: March 2008

Abstract: A retrospective study of Community Health Service patient records revealed 10 cases of urolithiasis in Aboriginal children under 5 years of age in a remote central Australian Aboriginal community over a 4 year period, out of a total under‐5 population estimate of 62. The highest attack rate was in the 0–2 age group, where nearly one in 10 children presented per year. All children had significant associated morbidity. Two children underwent pyelolithotomy.

Aboriginal children in the remote arid zone study community suffer exceptionally high rates of urolithiasis. Inadequate diet, dehydration and recurrent infectious disease are factors in pathogenesis. Further study may elucidate aetiology, but the implications of these data for improving environmental conditions and health service delivery in Aboriginal communities are urgent.
De novo terminal deletion of chromosome 7 [46, XX, del(7)(q35)]
Authors: LO BH , MURCH A. , CHABROS V. , WITHNELL R.
Published: March 2008

Objective: To report a new case of de novo 7q deletion distal to q35.

Methodology: Developmental, cytogenetic and audiological investigations were carried out in the assessment of this rare chromosomal condition.

Results: Moderate developmental delay, mild congenital microcephaly, growth retardation and conductive hearing impairment were found for this case of 46, XX, del(7)(q35).

Conclusions: The phenotype of 7q terminal deletion is highly variable.
Lead exposure and children's intelligence: Do low levels of lead in blood cause mental deficit?
Authors: DE SILVA PE , CHRISTOPHERS AJ
Published: March 2008

Objective:

It has come to be generally accepted that low levels of lead exposure may result in mental deficit. This causal inference is based on claimed time precedence of the lead exposure and on biological plausibility. The objective of this study is to argue that mental deficit causes pica which causes lead exposure (i.e. to support the theory of reverse causation).

Methodology:

The literature since the 1930s has been interpreted in the light of our own long experience in the investigation of lead exposure in children and adults to support the arguments in favour of reverse causation.

Results:

The arguments for reverse causation are based on: (i) analogy with mental retardation which causes increased lead exposure; (ii) the results of published prospective studies that show a special relationship between blood lead levels at 24 months and intelligence tested later, exactly what would be predicted by the reverse causation theory; and (iii) on an alternative explanation for mental retardation following lead encephalopathy (i.e. that mental retardation following encephalopathy is due to anoxia and not due to a direct destructive effect on the brain neurones). The arguments, which have been proposed for the conventional view, are rejected for the following reasons: (i) none of the prospective studies have found a relationship between cord blood lead levels and intelligence tested later, undermining the argument based on time precedence of lead exposure; and (ii) there is no convincing evidence that lead poisoning, short of encephalopathy, causes mental retardation.

Conclusion:

We believe that the reverse causation hypothesis is a more plausible explanation of the facts.
Preliminary study of glycopyrrolate in the management of drooling
Authors: STERN LM
Published: March 2008

Objective:

A study was undertaken to assess the efficacy of an oral anticholinergic drug, glycopyrrolate, in the management of drooling in children and young adults with disabilities.

Methodology:

Glycopyrrolate was used by 24 children and young adults for up to 28 months. Parents/carers were asked to complete a questionnaire on the effects of the drug on severity and frequency of drooling and to report any side‐effects.

Results:

Twenty‐two questionnaires were returned. There was a statistically significant decrease in both severity and frequency of drooling with minimal side‐effects reported.

Conclusion:

In this preliminary study, glycopyrrolate was found to be an effective and well‐tolerated addition to the management of drooling in children with disabilities.
High frequency ventilation
Authors: RAMSDEN CA , PILLOW JJ
Published: March 2008

The 1990s have seen a dramatic resurgence of interest in high frequency ventilation (HFV). The role of HFV in the rescue of infants failing conventional mechanical ventilation (CMV) is now relatively well established. However, the wider role of HFV in the routine management of respiratory failure in the newborn is more contentious. Recent trials in small numbers of infants suggest that HFV may be associated with significantly less chronic lung disease than CMV when used under optimal conditions (i.e. with a ‘high‐volume’ strategy, from early in the disease and continued to the point of weaning). Further, clinical trials are now required to define the role of HFV more clearly.
Foramina parietalia permagna: Report of nine cases in one family
Authors: KUTILEK S , BAXOVA A , BAYER M , LEISKA A , KOZLOWSKI K
Published: March 2008

Nine members of a family with foramina parietalia permagna (FPP), inherited as an autosomal dominant trait are reported. Although usually benign, FPP may be associated with other malformations.
The prevalence of hepatitis C in survivors of paediatric malignancy
Authors: Carter TL , Cole CH , Mews CF , Price PJ , Baker DL
Published: March 2008

Objective: To assess the prevalence of hepatitis C in 200 patients with paediatric malignancies, surviving in remission more than 5 years from diagnosis, who had received blood product transfusions before 1990 when routine screening of blood products for hepatitis C began.

Method: The second and third generation Abbott Diagnostics ELISA was used to assess hepatitis C seropositivity. Seropositive patients and those with abnormal liver transaminases were assessed by hepatitis C virus RNA polymerase chain reaction (PCR).

Results: A low incidence (4%) of seropositivity for hepatitis C was found in survivors of paediatric malignancy who were transfused prior to routine screening of blood products in this cohort.

Conclusions: All patients identified have evidence of hepatitis and may be at high risk of developing cirrhosis.
Persistent hypercholesterolaemia in frequently relapsing steroid‐responsive nephrotic syndrome
Authors: TSUKAHARA H , HARUKI S , HIRAOKA M , HORI C , SUDO M
Published: March 2008

Objective: To investigate long‐term changes of serum cholesterol levels in children with frequently relapsing steroid‐responsive nephrotic syndrome (NS).

Methodology: Serum cholesterol values just before and during or immediately after ‘relapse’ were reviewed and the incidence of hypercholesterolaemia (≥200 mg/dL) was determined in eight patients (M:F, 6:2).

Results: The patients with frequently relapsing NS usually showed hypercholesterolaemia (mean incidence, 81%) just before ‘relapse’ during clinical remission, as well as in relapse (mean incidence, 96%). A high incidence of steroid therapy was also found in each case (mean, 89%) just before relapse.

Conclusions: Our results demonstrate that children with frequently relapsing NS have prolonged periods of hypercholesterolaemia, even during clinical remission. It is suggested that serum lipid profiles be monitored carefully in such patients.
Disseminated pyomyositis with high creatine phosphokinase levels
Authors: KUYUCU N , DOGRU Ü , UYSAL G
Published: March 2008

Abstract: Pyomyositis is a rare purulent infection of skeletal muscle caused predominantly by Stapylococcus aureus. We report a patient who presented with high fever, widespread muscle pain and high creatine phosphokinase levels. He also developed multiple muscle and lung abscesses associated with a S. aureus septicaemia.
Proteus syndrome
Authors: NG SCY , KHOO BS , HO NK
Published: March 2008

Abstract: This female Asian (Malay) baby had clinical features of Proteus syndrome. She had a large right facial lipolymphangioma with hyperpigmentation of the overlying skin. There was a smaller lymphangioma over the left side of her neck with excess nuchal folds, macrodactyly and bilateral talipes equinovarus. Despite the extensive hemifacial swelling, there was no evidence of upper respiratory tract obstruction. Generalized seizures developed on the sixth day of life which were controlled with phenobarbital. The lymphangiomas were excised without recurrence.
Antibiotic management of pneumococcal infections in an era of increased resistance
Authors: GRIMWOOD K , COLLIGNON PJ , CURRIE BJ , FERSON MJ , GILBERT GL , HOGG GG , ISAACS D , MCINTYRE PB
Published: March 2008

Abstract: Pneumococci are a leading cause of bacterial meningitis and bacteraemia, as well as pneumonia, otitis media and sinusitis in childhood. These organisms recently have shown a dramatic increase in antibiotic resistance. Penicillin‐resistant pneumococci are of special concern as they are often resistant to other unrelated antibiotics. This is of particular significance to Aboriginal children who have among the highest rates of pneumococcal infection in the world. Laboratories should now test all invasive pneumococcal isolates for penicillin and third generation cephalosporin resistance. Local treatment guidelines are required for pneumococcal infections, especially for meningitis, taking into account the prevalence of resistant strains within the community. At present, penicillin and amoxycillin remain the drugs of choice for pneumococcal infections, with the exception of meningitis where initial empirical therapy must be with a third generation cephalosporin. Judicious antibiotic use, which avoids over‐prescribing and unnecessary use of broad‐spectrum agents, improved living standards in underprivileged communities and introduction of an effective conjugate vaccine, able to reduce the rates of pneumococcal infection and hopefully colonization, may limit the spread of resistant strains.
Phase 1 trial of a candidate rotavirus vaccine (RV3) derived from a human neonate
Authors: BARNES GL , LUND JS , ADAMS L , MORA A , MITCHELL SV , CAPLES A , BISHOP RF
Published: March 2008

Objective: To conduct a phase 1 safety and tolerability trial of an oral rotavirus vaccine candidate RV3 in healthy volunteers.

Methodology: Double blind placebo controlled trial of a single 1 mL oral dose (6.5 × 105 fluorescing focus units [FFU]/mL) in 10 healthy young men, 10 3–4 year old children and 10 3 month old infants with a 4 week surveillance period. The study was undertaken at a children's hospital and nearby community in Melbourne, Australia.

Results: All subjects successfully completed the trial. There were no significant side‐effects attributable to the vaccine preparation in any age group. No shedding of vaccine virus was detected by enzyme immunoassay. There was evidence of an. immune response in serum and/or gut secretions in two of five vaccinees in each age group.

Conclusion: RV3 rotavirus vaccine appears to be safe and well tolerated. Evidence of immunogenicity in some subjects after a single dose encourages further trials to determine immunogenicity after three doses, after reduction of viral dose, and without prior administration of buffer.
The influence of reported paternal attitudes on the decision to breast‐feed
Authors: SCOTT JA , BINNS CW , ARONI RA
Published: March 2008

Objective: To identify factors that influence a woman's decision to breast‐feed.

Methodology: Five hundred and fifty‐six women were recruited from the maternity wards of two Perth hospitals. Data were collected from a self‐administered questionnaire completed by participants prior to discharge. Logistic regression analysis was used to determine factors influencing the initiation of breast‐feeding.

Results: At discharge from hospital 83.8% of women were breast‐feeding, including 6% who were giving complementary formula feeds. After controlling for potentially confounding demographic and biomedical factors, the father's reported preference for breast‐feeding was found to be the most important factor influencing a woman's decision to breast‐feed (OR 10.18).

Conclusion: Fathers participate in and influence the choice of infant feeding method and should be included in breast‐feeding discussions.
Delayed umbilical cord clamping in preterm infants: A feasibility study
Authors: McDONNELL M , HENDERSON‐SMART DJ
Published: March 2008

Objectives: To assess: (i) the size of placental transfusion following a 30 s delay in cord clamping following vaginal and Caesarean births; and (ii) the feasibility of delaying cord clamping in the labour ward and particularly in the operating theatre.

Methods: Fourty‐six infants born at 26–33 weeks gestation were randomized to having the umbilical cord clamped either immediately or 30 s after birth. The venous haematocrit was measured at 1 and at 4 h of age.

Results: There were trends towards higher mean haematocrits in the infants following delayed clamping, but these were not significant either at 1 h (55±7.7 vs 52.9±7) or at 4 h of age (55±7 vs 52.5±7). The trends were more marked in the infants born by Caesarean section, and in those born at 26–29 weeks gestation.

Conclusions: A 30 s delay in cord clamping is feasible at both vaginal and Caesarean births, but does not lead to the predicted difference in infant haematocrit. Although physiological studies suggest that a placental transfusion of 15–20 mL/kg occurs within 30 s of delivery, these data suggest that future trials should either delay cord clamping for more than 30 s, or should alter the position of the infant in relation to the uterus in order to facilitate the transfusion. Delayed cord clamping is feasible at Caesarean section.
Comparing sulindac with indomethacin for closure of ductus arteriosus in preterm infants
Authors: NG PC , SO KW , FOK TF , YAM MC , WONG MY , WONG W
Published: March 2008

Objectives: A prospective study comparing the efficiacy and side‐effects of oral sulindac with intravenous indomethacin in clinically stable preterm infants (<1750 g) requiring non‐invasive closure of haemodynamically significant patent ductus arteriosus.

Methodology: As maturity and birthweight are the two major determinants of ductal closure, infants were matched as closely as possible for these parameters. An eligible patient was first assigned to the sulindac group and a subsequent patient with similar gestational age (± 1 week) and birthweight (±100 g) to the previously recruited infant would automatically receive indomethacin. A total of eight infants were enrolled in each group.

Results: The ductus arteriosus was successfully closed in all eight infants receiving indomethacin, and in seven of eight infants receiving sulindac. No significant differences were found with regards to the ductal size between the two groups at diagnosis or on each of the consecutive days of treatment (P>0.25). More renal adverse effects were encountered in the indomethacin group. Significant differences in changes from baseline value for urine output, plasma sodium, urea and creatinine concentrations were noted at 24, 48 and 72 h after commencement of treatment between the two groups (P<0.05). All the parameters returned to normal or pre‐treatment levels 48 h after stopping therapy. Unexpectedly, severe gastrointestinal complications were encountered in the sulindac group.

Conclusions: Sulindac is capable of promoting ductal constriction in clinically stable preterm infants without compromising the renal function. The spectrum of gastrointestinal complications observed in sulindac treated infants were similar to those described for indomethacin. The use of sulindac for ductal closure in the preterm infant should remain experimental.
Central diabetes insipidus in a newborn with deletion of chromosome 7q
Authors: NG PC , LEE CH , FOK TF , LAM STS , CHAN YL , WONG W , CHEUNG KL , CHAN WK
Published: March 2008

Abstract: We report an infant with midline craniofacial defects and holoprosencephaly due to chromosome 46, XY, del (7) (pter →q34) who presented at 1 week of age with central diabetes insipidus. The importance of hypothalamic‐pituitary endocrine investigation in patients with this syndrome, and more generally, in patients with midline craniofacial malformation or holoprosencephaly is emphasized. As infants with chromosome 7q deletion bear close phenotypic resemblance to infants of Trisomy 13, chromosomal confirmation and karyotype banding is mandatory to establish an accurate diagnosis and for genetic counselling of their parents.