bluuebunny/crossref_metadata_2025 huggingface dataset:
Paediatric dialysis and transplantation experience in Queensland
Authors: BURKE JOHN R. , HARDIE IAN R. , PETRIE JAMES J. B.
Published: March 2008

ABSTRACT. Between 1967 and 1981 27 children 6–15 years of age with end stage renal failure were treated in Queensland. The major cause of renal failure was reflux nephropathy (10). Actuarial graft survival was 55%, 50% and 35% at one, two and five years. Patient survival was 88%, 83% and 63% at one, two and five years. Seven deaths occurred, the major cause being hypertension in five children. Since 1978, patient survival has improved with a 93% survival at 3 years. Rehabilitation has been satisfactory with eleven of twelve school‐aged children now attending school full time.
The prevalence of obesity in Singapore primary school children
Authors: HO T. F. , CHAY S. O. , YIP W. C. L. , TAY J. S. H. , WONG H. B.
Published: March 2008

ABSTRACT. The purpose of this study is to survey the prevalence of obesity in Singapore primary school children from 1976 to 1980. The number of children screened comprised of 221,988 in primary I and 218,104 in primary VI. The male to female ratio was 1.04:1. Obesity is defined as body weight above 120% of Harvard standard weight for height. The overall prevalence rate was 3.51% with a significantly higher rate in boys (3.95%) than in girls (3.06%), p < 0.0001. This sex difference prevailed in both the primary I and primary VI group. Furthermore, primary VI students had a higher prevalence rate (4.29%) compared to the primary I students (2.75%) p < 0.0001. The prevalence rates were rising over the years with a rate of 5.33% in 1980 compared to that in 1976 (1.80%). Our observations suggest that the problem of obesity is an increasing one. The tendency to become obese increases with age and boys are more prone to obesity.
A longitudinal study of enuresis from five to nine years
Authors: McGEE ROB , MAKINSON TRACY , WILLIAMS SHEILA , SIMPSON ANNE , SILVA PHIL A.
Published: March 2008

The prevalence of primary and secondary enuresis was examined longitudinally in a large sample of New Zealand children at ages 5, 7, and 9 years. While the prevalence of primary enuresis fell over time, secondary enuresis increased in prevalence between 5 and 7 years. There were no sex differences. An examination of some of the developmental and background characteristics of the sample indicated that enuresis was not associated with neurodevelopmental delay or ‘psychosocial’ factors. However, there were strong, long term associations between secondary enuresis and behavioural deviance. The behavioural results suggested that behaviour problems did not arise as a consequence of enuresis, but rather preceded it.
Comparative study over a 12 year period of the weights of Tasmanian children from birth to 3 years of age
Authors: COY JOHANNA F. , LOWRY ROBERT K.
Published: March 2008

Abstract Comparisons of weight data obtained from surveys of Tasmanian children born in 1967–68, 1974 and 1979 suggest no change in birthweights but a significant decrease in weights at 1 year of age over this period. Evidence is presented to show that an observed increase in the incidence and duration of breastfeeding over the period may account for part of the decline in these weights but that other factors must also be involved. By 3 years of age there was very little difference between the weight distributions over the 12 year period.
Radiological services in a hospital Emergency Department — an evaluation of service delivery and radiograph interpretation
Authors: NOLAN TERENCE M. , OBERKLAID FRANK , BOLDT DAVID
Published: March 2008

Abstract Radiological services to the Department of Ambulatory Paediatrics were audited over 1 month. Of a total of 782 separate radiographs, more than two‐thirds were performed outside hours when radiologists are normally in the hospital. For only 171 of the 782 radiographs (22%) were there immediate reports by a radiologist.

To determine whether the absence of immediate radiologist reports affected clinical care, a process was introduced whereby radiologists reviewed interpretation of radiographs made by resident medical officers (RMO) when no report was available. Over a 5 month period 2888 patients had radiographs when there was no immediate radiologist's report. Comparisons were made between RMO interpretation and ultimate radiologist report in 1411 of these patients. In 232 cases (16.4%) there was a discrepancy between RMO interpretation and radiologist report; 70% of these were false positive (the RMO interpreting a normal film as abnormal) while 71 were false negative (the RMO interpreting an abnormal film as normal).

This study demonstrates the utility of a relatively simple quality assurance measure in situations where clinical decisions have to be made in the absence of an immediate radiologist report.
Reliability of mothers' reports of birth data
Authors: OATES R. KIM , FORREST DOUGLAS
Published: March 2008

To determine the reliability of recall of birth and early childhood events, a group of 47 mothers was asked details of their child's birth and about any child‐rearing problems at an average of 5–6 years after the birth. Thirty‐four of these mothers were asked similar questions 3 years later. The information given by the mothers was compared with the information documented in the hospital records when the children were born. The mothers overestimated the length of pregnancy and overestimated the number of neonatal problems. Only half could recall the birth weight accurately. When asked the same questions 3 years later there was a tendency for memory to have mellowed with fewer pregnancy complications and child‐rearing difficulties being recalled than on the previous interview. Information given by mothers about such objective data as length of gestation, birth weight and obstetric complications is not necessarily accurate. Less objective data may be recalled even less accurately.
Biochemical diagnosis of Type 1b glycogen storage disease
Authors: HAWKINS R. A. , KAMATH K. R. , DORNEY S. F. A. , ADAMS A.
Published: March 2008

A child with the classical signs and symptoms of Type 1 glycogen storage disease is presented who on investigation was shown to have a recently described variant of this disease known as Type 1b glycogen storage disease. A reliable and simple procedure for the diagnosis and differentiation of Types 1 and 1b glycogen storage disease is described, as the conventional diagnostic approach of assaying glucose‐6‐phosphate phosphohydrolase in frozen tissue will not diagnose Type 1b glycogen storage disease.

A portion of biopsy tissue should be maintained at a temperature near 0°C (but not frozen) and the remainder frozen. Glucose‐6‐phosphate phosphohydrolase assays are carried out on the tissue homogenates of both portions. In Type 1 glycogen storage disease, glucose‐6‐phosphate phosphohydrolase activity will be tow or absent in both frozen and unfrozen tissues. In Type 1b glycogen storage disease the frozen tissue homogenate will exhibit normal glucose‐6‐phosphate phosphohydrolase activity due to the disruption of the microsomes by tee crystals, white in the unfrozen tissue low levels of glucose‐6‐phosphate phosphohydrolase activity will be detected.
The antidiuretic hormone response to therapy for acute asthma
Authors: DAWSON K. P. , MANN D. W. , FERGUSSON D. M. , SADLER W. A.
Published: March 2008

Abstract The plasma antidiuretic hormone concentrations in eight asthmatic children were measured at the onset of an acute severe attack and were repeated 24 h later. Conventional therapy and maintenance fluid intake resulted in a significant fall in antidiuretic hormone concentrations without abnormal changes in other biochemical indicators of dehydration.
Low birth weight in Tasmania 1975‐1983: The effect of socioeconomic status
Authors: LUMLEY JUDITH , CORREY J. F. , NEWMAN N.M. , CURRAN J.T.
Published: March 2008

An analysis of all births in Tasmania from 1975 to 1983 showed that social class differences in low birth weights were almost entirely restricted to infants between 1500 and 2500 g weight at birth. There was a marginal increase in very low birth weight infants (<1500 g) among women whose partners were unemployed or in unskilled work but extremely low birth weight infants (<1000 g) were evenly distributed across the whole social spectrum.
Sacrococcygeal teratoma
Authors: LEUNG ALEXANDER K. C. , RUBIN STEVEN Z. , SEAGRAM GEOFFREY F. , HWANG WEI S.
Published: March 2008

Abstract Eight cases of sacrococcygeal teratoma are described. Seven patients were diagnosed at birth, and one presented at 3 1/2 months of age with urinary retention. Two patients had associated congenital anomalies (arachnoid cyst, external angular dermoid and bifid sacrum), while one had a family history of sacrococcygeal teratoma. All had the tumour removed together with the coccyx as soon as the diagnosis was made. None had recurrence of the tumour.
Mortality and two year outcome of infants of birthweight 500‐1500 g: relationship with neonatal cerebral ultrasound data
Authors: KITCHEN WILLIAM H. , FORD GEOFFREY W. , MURTON LAURENCE J. , RICKARDS ANNE L. , RYAN MARGARET M. , LISSENDEN JEAN V. , DE CRESPIGNY L. CHAMPION , FORTUNE DENYS W.
Published: March 2008

Cranial ultrasounds were performed on 218 (96%) of 227 liveborn infants of birthweight 500‐1500 g delivered in the Royal Women's Hospital, Melbourne, Australia, in an 18‐month period concluding in March 1982. Seventy‐two (31.7%) of the children died; 28 children (38.9%) had cerebroventricular haemorrhage, 35 (48.6%) showed no bleeding and there were nine (12.5%) with no data. Paired necropsy and ultrasound data were congruent in 22 (88%) of 25 children. One hundred and forty‐eight (95.5%) of 155 survivors were seen at 2 years of age. Forty‐one (28%) had cerebroventricular haemorrhage; nine children (6%) had both ventricular dilatation and haemorrhage and two had ventricular dilatation alone. Apart from a marginal advance in gestation and higher number of immigrant and less educated mothers in children without cerebroventricular haemorrhage, all other perinatal, biographical and social variables between those with haemorrhage and those without were similar. The major handicap rate overall was 14.2% (21 patients). The children with cerebroventricular haemorrhage had a trend for greater prevalence of handicap and lower mean Bayley psychological scores. This was even more evident with ventricular dilatation being present. Of children with major handicap 57.1% (12/21) had normal serial ultrasound findings during their primary hospitalization. Major handicap occurred in 15% (3/20) of children with grade 1 haemorrhage, 23.5% (4/17) with grade 2 or 3 bleeds and 25% (1/4) of those with grade 4 haemorrhage. Laterality of cerebral palsy did not correlate with ultrasound findings. Ultrasound findings did not improve statistical prediction of deaths or major handicap.
A Case of ring 20 chromosome with cardiac and renal anomalies
Authors: BURNELL R. H. , STERN LEON M. , SUTHERLAND GRANT R.
Published: March 2008

A case of ring 20 chromosome is reported. In contrast to the few children documented previously with this problem who had no significant malformations the present case had major malformations of the heart and urinary tract as well as mental retardation and seizures.
Chlormethiazole: An effective oral sedative for cranial CT scans in children
Authors: STANLEY THORSTEN V.
Published: March 2008

Abstract Oral chlormethiazole was assessed as an alternative form of sedation for cranial computerized axial tomography in children aged 0–9 years. It was found to be highly effective with a rapid onset of action, brief period of action and no side effects. It was found to be preferable to intramuscular lytic cocktail, being particularly suitable for day cases. Chlormethiazole might lend itself to use in other non‐painful procedures in childhood.
Late development of airway obstruction in the Robin anomalad (Pierre Robin Syndrome) in the newborn
Authors: OGBORN MALCOLM R. , PEMBERTON PATRICK J.
Published: March 2008

Abstract A survey of the records of 26 consecutive cases of the Robin anomalad, admitted in the first year of life, was undertaken to review the time at which airway obstruction was first noted to occur after birth.

Sixteen cases required active treatment for episodes of airway obstruction associated with cyanosis. Of these, 11 developed obstruction on the first day of life, but five did not obstruct until later (3–21 days). Two infants, both from the early presentation group, died as a result of airway obstruction at 13 and 95 days of age. Management techniques varied over the 11 year period studied, and included prone nursing, body frame, naso‐tracheal intubation, nasopharyngeal intubation, and lip tongue anastamosis. Tracheostomy was not performed on any case.

There is a significant risk of major airway embarrassment in this disorder (16 of 25, 62%) even if the infant seems initially well (five of 26, 18%). Early management of infants with the Robin anomalad should, therefore, be undertaken at centres where skilled airway support is available.
Gastrointestinal hypersensitivity to cow's milk protein: The diagnostic value of gut function tests
Authors: FORD RODNEY P. K. , BARNES GRAEME L. , HILL DAVID J.
Published: March 2008

Thirty‐six children with suspected gastrointestinal hypersensitivity to cow's milk protein were investigated before and after challenge with cow's milk protein by one or more of four tests of gut function: the appearance of small bowel mucosa, mucosal disaccharidase levels, a 1‐h blood‐xylose test, and a 50 g‐lactose breath‐hydrogen test. These tests were not always abnormal in children who had definite adverse reactions to milk. Conversely changes were seen in some with negative milk challenges. Although small bowel biopsy, assessment of disaccharidase activity and perhaps the breath‐hydrogen test have an importannt place in the pre‐challenge assessment to exclude other causes of gastrointestinal symptoms, these gut function tests and the 1‐h xylose test done following milk provocation do not appear to have any advantage over careful clinical observation.
Education in childhood asthma: A preliminary study of need and efficacy
Authors: VAN ASPEREN PETER , JANDERA EVA , DE NEEF JOYCE , HILL PETA , LAW NERIDA
Published: March 2008

This study initially assessed in parents of children with asthma, their knowledge of the condition and its management. Using a knowledge questionnaire a mean score for 30 parents of 69.1% was found, with a range between 44% and 86%. The study went on to examine whether an educational intervention program for parents could both improve knowledge and lower morbidity. The results for 14 parents who completed the educational intervention program were compared to those for 14 parents who did not complete the program. Both groups showed an increase in knowledge at 1 and 3 months after their initial interview (P<0.005) but the active group had significantly better knowledge at 1 month (P<0.0001) and 3 months (P< 0.001) compared to the control group. There was no change in morbidity in either group as assessed by hospital admissions, visits to a doctor, days off school and number of wheezing episodes. We have shown that knowledge can be improved by an educational program for parents of children with asthma but have not been able to demonstrate an effect on short‐term morbidity.
Screening for congenital hypothyroidism in Hong Kong
Authors: LOW L C. K. , LIN H. J. , CHEUNG P. T. , LEE F. T. , CHU S. Y. , KWOK T. L. , BACON‐SHONE J. , YEUNG C. Y.
Published: March 2008

A pilot cord blood TSH screening program for congenital hypothyroidism was commenced in Hong Kong in April 1982. By April 1984, 14 411 neonates born in two hospitals were screened for this disorder. Five cases of primary hypothyroidism and two cases of transient hypothyroidism were detected. The detection of cases of congenital hypothyroidism with only moderately elevated cord blood TSH values means that the recall rate will remain high.
Transcutaneous bilirubinometer: Its use in Chinese term infants and the effect of haematocrit and phototherapy on the TcB index
Authors: FOK TAI‐FAI , LAU SAM‐PING , HUI CHIK‐WING , FUNG KAM‐PUI , WAN CHUN‐WAI
Published: March 2008

The application of the transcutaneous bilirubinometer in screening for neonatal jaundice was evaluated in 259 full‐term Chinese infants: 202 who had not received any treatment and 57 who were receiving phototherapy. The transcutaneous bilirubin index correlated well with the serum bilirubin level (SB) of the untreated infants and the coefficient of correlation was slightly higher for TcB readings obtained over the mid‐sternal area (r=0.91; P<0.001) than those over the forehead (r=0.85; P<0.001). Transcutaneous bilirubinometry was unreliable in predicting the SB level in infants receiving phototherapy even if the SB readings were obtained over shaded skin. The haematocrit of the infants, though having a statistically significant effect on the TcB index, contributed only minimally to the regression line and correlation coefficient between the TcB index and SB level.
Liver transplantation in children: Experience with the development of an Australian pilot programme THE QUEENSLAND LIVER TRANSPLANTATION PROGRAMME*
Authors: Shepherd R.W. , Powell L. W. , Cleghorn G. J.
Published: March 2008

Children with end‐stage liver disease now form a major sub‐group of patients considered suitable for liver transplantation (ltp), and enjoy better survival statistics after transplantation than do adults. Since June 1984, a paediatric ltp programme has been developed in Brisbane with an initial working relationship and ongoing close links with two USA centres (Pittsburgh, and the UCLA Medical Center).

Fourteen children with end‐stage liver disease have been referred to the Queensland Liver Transplantation Programme for formal assessment. Following frank, informed discussion with their parents, 10 of these children were offered the option of ltp. During the transition stage, two infants with biliary atresia were referred to UCLA at their parents' request and, subsequently, eight children aged from 9 months to 6 years have been placed on a transplant candidacy list in Brisbane. A donor procurement team with access to a Queensland Government jet has been available to cover all mainland States except Western Australia. Six of the children have now had orthotopic ltp (two children at the UCLA Medical Center; four children at the Royal Children's Hospital, Brisbane). One UCLA patient died with a non‐functioning graft, and one Brisbane patient died 5 weeks post‐transplant with rejection, hepatic artery thrombosis and sepsis. The other four children are alive and well, three with normal liver function and one with unexplained intrahepatic cholestasis, during the 1‐20 month follow‐up to date. Three further children have died of their liver disease without a donor of an appropriate blood group and size being found, and one patient still awaits a suitable donor.

The experience of these authors suggests that ltp is a major advance in the treatment of paediatric liver disease, and that the procedure can be carried out successfully in Australia with initial results comparable with leading overseas centres. The procedure requires the full array of services of a major paediatric tertiary care facility, an intensive team effort with awareness of the special needs of children, and a widespread procurement capability. A major problem for Australia is the procurement of sufficient numbers of optimal paediatric donor livers.
A comparative study of a premature infant formula and preterm breast milk for low birthweight infants
Authors: TUDEHOPE D. I. , MITCHELL F. , COWLEY D. M.
Published: March 2008

Although the unique composition of preterm milk (PTM) has led to its increasing use in feeding of low birthweight (LBW) infants, controversy exists as to whether such milk adequately meets their requirements. This study compares the clinical tolerance and anthropometric, biochemical and haematological parameters of LBW infants fed exclusively with their own mother's PTM, a premature infant formula (Alprem; Nestlé Australia) and a mixture of PTM and Alprem. Of 90 enrolled LBW infants (1000‐1750 g birthweight), 78 completed the feeding trial for a mean duration of 42 days. Twenty‐eight babies were fed Alprem (Group A), 31 received a mixture of Alprem and PTM (Group B) and 18 received PTM (Group C). Babies in Groups A and B were smaller, less mature and more asphyxiated at birth than those in Group C.

Weight gain from full enteral feeding was greater in Group A (18.1 g/kg per day) and Group B (17.6 g/kg per day) than in Group C (13.0 g/kg per day). Throughout the trial, weight gain in Groups A and B exceeded predicted intra‐uterine growth rates, whereas that for Group C approximated the predicted intra‐uterine growth rates. Growth rates of length and head circumference were also greatest in the Alprem‐fed babies. Infants receiving PTM were supplemented with calcium, sodium, vitamins and energy, whereas the only three infants requiring mineral supplementation in the Alprem group were those receiving Frusemide therapy for chronic lung disease.

Lower serum concentrations of phosphorus, iron, albumin and urea, and higher zinc and alkaline phosphatase concentrations were found in infants receiving PTM (P<0.05). Overall both PTM and Alprem were well tolerated with the four cases of necrotizing enterocolitis and five cases of transient gastrointestinal intolerance distributed equally among the groups. Alprem is a satisfactory alternative to PTM for the feeding of LBW infants as it provides adequate nutrition and supports a growth rate in excess of that in utero without stressing the infant's metabolic or excretory systems.
The response of asthmatic children to the heated nebulization of Salbutamol
Authors: UNTER C. E. M. , ALLAN J. , DAWSON K. P.
Published: March 2008

The effect of a nebulized solution of Salbutamol heated to 37°C was compared with that of Salbutamol nebulized in the standard manner. Forty asthmatic children were assigned randomly to a heated or standard nebulization. Each child received randomly either half or the full recommended dose of Salbutamol on separate occasions. No untoward side effects were observed. Baseline measurements of peak exploratory flow rate (PEFR), forced vital capacity (FVC) and 1 s forced expiratory volume (FEV1) were not significantly different among the groups. There was no statistically significant difference among the groups when assessed 15 min after treatment, indicating that neither a change in temperature nor in dose had any significant effect on response at this time. It is concluded that at the dosages used there is no advantage in heating nebulized Salbutamol to 37°C. The equipotent effect of half the recommended dose of Salbutamol at both temperatures suggests that the recommended dose of Salbutamol is too high and that the lowest optimal dose needs to be ascertained.
Circumcision in Australia: An update
Authors: WIRTH J. L.
Published: March 2008

National health insurance statistics on neonatal and non‐neonatal circumcisions in Australia and in individual Australian states are updated.
Acute cervical lymphadenitis in children
Authors: WRIGHT J. E. , REID I. S.
Published: March 2008

A retrospective study of 78 children with acute cervical lymphadenitis treated in Newcastle over the last 9 years revealed that abscesses formed in 50 children despite antibiotic treatment. Children under 2 years of age were more likely to form an abscess than older children. The commonest organism isolated was penicillin‐resistant Staphylococcus. Beta‐haemolytic Streptococcus was isolated less commonly and isolation of penicillin‐sensitive staphylococci was rare. Penicillin and amoxycillin alone are unsuitable as first line antibiotics. Severe infections and those failing to respond rapidly to initial antibiotic treatment should be admitted to a paediatric unit for intravenous beta‐lactamase‐resistant antibiotics.
Food intake at age 8 3. Distribution and food density by meal
Authors: MAGAREY A. , NICHOLS J. , BOULTON J.
Published: March 2008

This report describes how nutrient intake was distributed throughout the day, and the nutrient density according to meal, in 78 boys and 63 girls who have been studied from birth. The food intake was calculated from 4 day weighed records using the CSIRONET data bank based on British tables of food composition.

The percentages of total energy from breakfast, lunch, evening meal, and snacks were 20, 26, 31, 23%. There was a very wide range of individual nutrient intake for each meal. The evening meal made the largest contribution to fat and protein intake. Most starch came from lunch (30%) and least from snacks (16%). Snacks contained a large portion of the simple sugars (39%).

Breakfast was an important source of calcium and B vitamins, but with wide ranges of micronutrients occurring for each meal.

This analysis of nutrient density and distribution contributes towards the formulation of practical recommendations about beneficial dietary changes.
Adrenal haemorrhage presenting as an abdominal mass in the newborn
Authors: WRIGHT J. E. , BEAR J. W.
Published: March 2008

Adrenal haemorrhage in the newborn, an entity well recognized at autopsy and as a cause of massive haemorrhage, may present as an asymptomatic abdominal mass. Three cases of neonatal adrenal haemorrhage are described and the literature is reviewed. Most of the affected babies were of normal birthweight, full term and with no history of difficult delivery or neonatal asphyxia. Most presented with a flank mass and jaundice. The haemoglobin was not always low. Intravenous urography and sonography were the investigations of choice. The most serious condition in the differential diagnosis is neuroblastoma, but the chance of this presenting in the newborn period with normal catecholamine secretion and no evident metastases is sufficiently rare to justify expectant management. Follow‐up physical examination and repeat sonography at 1 month are recommended. This interval is long enough to allow resolution of a mass caused by adrenal haemorrhage.
Longitudinal study of very low birthweight infants: Intelligence and aspects of school progress at 14 years of age
Authors: RICKARDS A. L. , RYAN M. M. , KITCHEN W. H.
Published: March 2008

Abstract Consecutive surviving children weighing less than 1501 g when born in 1966–70 were followed prospectively: 87% (146/168) attended normal secondary schools, 4% (7/168) attended schools for those with special needs and 9% (15/168) were untraced. The psychologist assessed 140 children at a mean age of 14.5 years. The mean WISC‐R Verbal Score of 89.7 was almost identical to that achieved by the children at 8 years of age (89.2). Thirty three children (24%) had delay in Reading Accuracy on the Neale Analysis of Reading Ability, whilst 66 children (48%) were delayed on the Comprehension Scale. Social class and duration of maternal education were significant predictors of the WISC‐R Verbal Scores and Reading Comprehension at 14.5 years but the total variance explained was small. The Bayley Development Index (MDI) available for half of the children at 2 years often underestimated their potential as defined by the WISC‐R Verbal Score at 14.5 years. The 8 year intelligence (WISC‐R) and reading measures (Neale) were significantly and highly associated with the corresponding measures at 14.5 years. It was concluded that 8 years was an appropriate age to evaluate the outcome of the children and to identify many of those needing educational intervention. The spasmodic nature and sometimes short duration of the help received by many of the children underlines the need for more appropriate intervention for children with learning difficulties.
Haematolytic disease due to ABO incompatibility: Incidence and value of screening in an Asian population
Authors: HAN P. , KIRUBA R. , ONG R. , JOSEPH R. , TAN K. L. , WONG H. B.
Published: March 2008

Abstract The population in Singapore is predominantly Asian, with Chinese forming the major ethnic group. The incidence of haemolytic disease of the newborn (HDN) due to Rh incompatibility is very low. The true incidence of HDN due to ABO incompatibility is unknown. Early discharge is practised in Singapore making it important to predict severe HDN due to ABO incompatibility as this would constitute the main cause of haemolysis next to G6PD deficiency. One thousand, six hundred and eight baby‐maternal pairs were typed for ABO, Rh, and tested for direct Coombs’test, maternal titre, cord bilirubin and haptoglobin levels. Two hundred and fifty‐one were found to be ABO incompatible, with 141 group A and 110 group B babies. The incidence of HDN due to ABO incompatibility was 3.7% of all group O mothers. Coombs’test, maternal antibody titre, cord bilirubin and haptoglobin levels were of low predictive value for severe HDN due to ABO incompatibility. The data further support the notion that it is not cost effective to screen for ABO incompatibility.
Muscular strength at 5 years of children with a birthweight under 1500g
Authors: FORD G. W. , Kitchen W. H. , DOYLE L. W.
Published: March 2008

Abstract The hand‐grip strength was measured as part of the 5‐year neurodevelopmental assessment of 24 very low birthweight (VLBW) and 18 normal birthweight (NBW) children. Hand‐grip strength was significantly lower in the VLBW children for left and right hands tested individually and for both hands used concurrently. Increasing hand‐grip strength was significantly related to 5‐year weight percentiles and to being in the NBW group. More of the VLBW children weighed less than the 10th percentile. After adjusting for the 5‐year weight percentile, the hand‐grip strength of VLBW children was still significantly lower than that for NBW children. This is another aspect of development in which VLBW children are disadvantaged.
Neonatal cranial ultrasonography as predictor of 2 year outcome of very low birthweight infants
Authors: TUDEHOPE D. I. , MASEL J. , MOHAY H. , O'CALLAGHAN M. , BURNS Y. , ROGERS Y. , WILLIAMS G.
Published: March 2008

Abstract Real time ultrasound scans using an ATL 300C sector scanner with 5–7.5 MHz transducer were performed on days 1, 4, 7 and thereafter as clinically necessary on 153 consecutively discharged very low birthweight (VLBW) infants. One hundred and forty‐six long‐term survivors were assessed fully at 2 years. The prevalence of cerebroventricular haemorrhage (CVH) in these survivors was 34.2% (grade 1—21.2%; grade 2—4.8%; grade 3—3.4%; grade 4—4.8%), ventricular dilatation 19.9% (including 4.1% with ventriculoperitoneal shunt), and ischaemia 9%. Impairments at 2 years were classified as nil, mild, moderate, severe or multiply severe, based on the criteria of Kitchen et al.

Overall, 120 infants (82.2%) were unimpaired and 6.2% had mild, 3.4% had moderate, 4.1% had severe and 4.1% had multiply severe impairment. The major factors associated with impairment were gestational age < 28 weeks, birthweight < 1000 g, vaginal delivery, respiratory distress syndrome, mechanical ventilation, pulmonary air leaks and CVH. When these factors were reanalysed in a logistic regression model for odds ratios, only CVH (P < 0.005) and birth by spontaneous vaginal delivery (P < 0.05) were significant. The prevalence of impairment was 11.4% with no CVH, 6.5% grade 1, 71% grade 2, 20.0% grade 3 and 100.0% grade 4 CVH. The sensitivity of CVH of grade 2 or greater as a screening test was 64.7% for impairment, 78.6% for cerebral palsy and 70% for severe intellectual handicap. The mean general quotient (GQ) (Griffiths) at 2 years for infants with CVH was 89.1, and 97.5 for those without CVH (P < 0.001). Although infants with ventricular dilatation had an average GQ that was 13.1 units less than those with normal ventricles, the difference was only significant in those with a CVH of grade 2–4.

The study shows the sonographic diagnosis of CVH and ventricular dilatation, but not ischaemia, to be a useful adjunct in predicting impairment and intellectual performance in VLBW infants but does not replace the need for multidisciplinary follow‐up.
Brain stem encephalitis due to herpes simplex virus
Authors: ROBB L. , BUTT W.
Published: March 2008

Abstract A 6 year old child is described with infection due to herpes simplex virus type 1 causing brain stem encephalitis. The diagnosis was established by enzyme immunosorbent assays of the cerebrospinal fluid and serum which demonstrated antibody responses to herpes simplex virus. Recovery occurred and the importance of early use of acyclovir in achieving a good outcome is emphasized.
Congenital adrenal hyperplasia family studies using the short ACTH test
Authors: KREUTZMANN D. J. , COWELL C. T. , HOWARD N. J. , SOUZA M. De , SILINK M.
Published: March 2008

Abstract Because of the increasing use of 17‐hydroxyprogesterone (17OHP) levels with the short adrenocorticotrophic hormone (ACTH) test in the detection of 21‐hydroxylase deficiency, the diagnostic efficiency of the test was evaluated in patient and family studies of congenital adrenal hyperplasia due to 21‐hydroxylase deficiency and of congenital adrenal hyperplasia due to 11‐hydroxylase (11OH) deficiency (the latter disorder now overlapse basally with the milder non‐classical 21‐hydroxylase deficiency [NC‐CAH]).

Stimulated 17‐hydroxyprogesterone level (17OHP30), 17‐hydroxyprogesterone increase (Δ17OHP) and the ratio 17‐hydroxyprogesterone increase to cortisol increase (Δ17OHP/Δcortisol) were the parameters from the short ACTH test derived for assessment. 17‐OHP30 provided complete differentiation of NC‐CAH from the controls and heterozygotes, but overlap between NC‐CAH and 11‐OH occurred. Complete differentiation of NC‐CAH from 11‐OH was achieved using Δ17OHP. The heterozygotes showed best differentiation from the controls using Δ17OHP/Δcortisol with a diagnostic accuracy of 70%, however marked overlap of heterozygotes and NC‐CAH with 11‐OH was found.

The short ACTH test proved to be a valuable technique with the further detection of homozygotes (n= 3) and heterozygotes (n= 5) in the 13 families studied. However, when interpreting the short ACTH test a careful choice of parameters should be made. It should be kept in mind that mild NC‐CAH patients can only be differentiated from 11OH patients by using Δ17OHP.
Outcomes following the use of rational guidelines in the management of jaundiced newborn infants
Authors: COCKINGTON R. A. , DREW J. H. , EBERHARD A.
Published: March 2008

Abstract In 1975, rational guidelines for management of the jaundiced newborn infant were introduced to the Mercy Maternity Hospital, Melbourne. The guidelines were produced as four charts, each chart covering a particular birthweight range. The charts have been used widely.

The effect of introduction of the charts has been examined by comparing the years 1971–74 with 1975–77. An overall decrease occurred in the use of phototherapy, without an increase in the use of exchange transfusion or in those with a serum bilirubin level above 339 μmol/L. The difference was not explained by an alteration in the spectrum of causes of jaundice. Long‐term follow‐up of jaundiced infants managed according to these guidelines revealed a satisfactory outcome despite a significant reduction in active treatment. The associated avoidance of potential side effects of treatment of the jaundiced newborn infant warrants consideration of the use of these charts by other neonatal units.
Faecal incontinence in childhood: A multidisciplinary approach including biofeedback
Authors: SHEPHERD K. , HICKSTEIN R. , ROSE V. , NASSER C. , CLEGHORN G. J. , SHEPHERD R. W.
Published: March 2008

Abstract One hundred and seven children with faecal incontinence were evaluated and managed over a 3 year period by a multidisciplinary team. After initial clinical assessment, evaluation of defaecatory mechanisms (using a balloon model) and assessment of personal‐social development and self‐concept were undertaken. Management was based on initial bowel evacuation, short‐term laxatives, and habit training involving systematic use of positive reinforcement; 69 children received biofeedback conditioning. Idiopathic megacolon with constipation and soiling was the most common finding (98 cases). Other diagnoses included previously undiagnosed neurogenic bowel (three cases), post‐surgical anal anomalies (four cases), and psychogenic encopresis (two cases). Idiopathic megacolon was characterized by decreased rectal sensation, increased threshold for external sphincter relaxation and an inability to evacuate. Faecal incontinence was associated with an undesirably low social self‐concept (70% of the 40 evaluated), but was not related to a delay in development (mean general developmental quotient = 105 ± 8, for the 35 tested). Family psychopathology warranting referral for family therapy was found in 14 children (13%). The management programme yielded a short‐term (3 months) cure rate of 68% and a long‐term (12 months) cure rate of 90%, with 10% having continued soiling which varied from occasional to several incidents/week. No significant improvement in self‐concept was observed overall, although marked improvements were observed in some children. We conclude that disordered defaecatory dynamics are a major determinant of faecal incontinence in children. Undesirably low social self‐concepts but normal developmental ability accompany this condition. Management is facilitated by a multidisciplinary approach, acknowledging the role of both behavioural and physiological components of the problem. This approach is effective in eradicating soiling in the majority of cases, comparing favourably with other published data.
Fetal echocardiography in the diagnosis of congenital heart disease
Authors: MELLICK J. D. , RADFORD D. J. , GALBRAITH A. J.
Published: March 2008

Abstract Fetal echocardiography provides an opportunity to diagnose congenital heart disease as early as the midtrimester of pregnancy, allowing for proper planning of perinatal care and counselling of the parents. This paper reviews the accuracy and outcomes of fetal cardiac ultrasound studies at The Prince Charles Hospital over the past 4 years.

A total of 43 fetuses, of gestational ages 16–39 weeks, were studied. The indications for these were: previous sibling with cardiac anomaly (16 cases); abnormal heart on obstetric ultrasound scan (USS) (13 cases); abnormalities found on obstetric USS with normal appearing heart (one case); fetal bradycardia (seven cases); fetal tachycardia (four cases); irregular fetal heart beat (two cases).

At birth all fetuses assessed because of a previously affected sibling were normal. Of the 13 referred because of structural heart lesions suspected on obstetric USS, eight were abnormal, four were normal and one was terminated without autopsy. Important rhythm disturbances occurred in nine of the 11 referred because of abnormal heart rates. One false positive diagnosis of a possible coarctation was made, and in four cases an abnormality was noted on USS but the diagnosis was not completely correct. Nine of the 19 infants with abnormalities detected have died.

Fetal echocardiography is an accurate and useful method of diagnosing congenital heart disease in utero. Although the mortality of affected fetuses is high, antenatal diagnosis allows planning of medical care and offers the greatest chance of a successful outcome.
Radiological and clinical features of basal ganglia infarction in tuberculous meningitis
Authors: TANG P. S. , LOW L. C. K.
Published: March 2008

Abstract A patient with choreoathetosis and dystonia who had computerized tomography evidence of basal ganglia damage resulting from tuberculous meningitis is presented. It is important to distinguish these extrapyramidal movements from fits, and the observation of such movements in a clinical setting of meningitis should alert physicians to the diagnosis of tuberculous meningitis.
Congenital tuberculosis
Authors: LI C‐K. , CHAN Y‐F. , HAR C. M. Y.
Published: March 2008

Abstract A 7 week old baby presented with generalized lymphadenopathy, obstructive jaundice and massive hepatosplenomegaly. The clinical picture closely resembled a case of disseminated malignancy. Soon after the diagnosis of tuberculosis was made by pathological examination of a lymph node, the patient died. An autopsy revealed primary tuberculous foci in the liver and massive lymphadenopathy at the porta hepatis consistent with transplacentally acquired tuberculosis. The importance of early diagnosis and treatment of this rare condition is emphasized.
Systemic candidiasis with DIC and candida endophthalmitis in a postoperative neonate
Authors: DOI O. , TAKADA Y. , YAMAUCHI Y. , OGAWA T.
Published: March 2008

Abstract A full‐term male neonate, weighing 2540 g at birth, was admitted to hospital on day 2 because of vomiting and severe dehydration. Duodeno‐duodenostomy was performed on day 5 for congenital duodenal atresia. The child was well postoperatively until day 9, when he developed fever. Intermittent fever continued despite treatment with several antibiotics. He became seriously ill on day 15 and developed disseminated intravascular coagulation. Treatment with antifungal drugs (amphotericin B and 5‐flucytosine) was effective for systemic candidiasis, but candida endophthalmitis developed. There was a persistent vitreous lesion in the left eye, which after cessation of therapy has been improving gradually. Systemic candidiasis and candida endophthalmitis should be considered in neonates who develop signs of sepsis postoperatively.
It's time: The future of school health in Australia
Authors: OBERKLAID F.
Published: March 2008

School medical services in Australia have a long tradition of providing community‐based services to school‐aged children, and in some states to preschool children. Conceived as a public health measure early this century, doctors and nurses worked in schools to address the health issues of the time, which were largely to do with nutrition, hygiene, and infectious diseases.1 It was perceived that many children had poor access to medical care, and began school with unaddressed health problems which often had a deleterious effect on their learning. Doctors were often employed by education authorities and only transferred to health departments many years later. In some states the service was expanded subsequently to include preschool children, based on the concept that the earlier problems were detected the earlier they could be treated appropriately and the greater the benefits to the child.

While social structures, community needs and paediatric morbidity patterns have changed dramatically over recent years, there is a widespread perception that in some states school medical services have not yet embraced fully the changing needs of the population of school children they are designed to serve. Hamstrung by political expediency (with decision‐making driven by political rather than scientific considerations) and bureaucratic inertia, school nurses and doctors often operate in structures and systems that are urgently in need of review and reorganization. In this paper the rationale for current processes will be reviewed critically, a model of school health services focused on contemporary paediatric needs is proposed, and a set of factors which are considered essential to the development of the school health services of the future is outlined.
Congenital teratomas of the neck and nasopharynx: A clinical and pathological study of 18 cases
Authors: BYARD R.W. , JIMENEZ C.L. , CARPENTER B.F. , SMITH C.R.
Published: March 2008

Abstract Congenital teratomas of the neck and nasopharynx are unusual tumours that seldom metastasize. Due to their rarity, reviews often have relied upon compilations of isolated case reports. We report our experience of the early outcome of 18 cases (14 cervical, four nasopharyngeal) to demonstrate the high morbidity and mortality that these benign but critically placed lesions have because of local mass effects. Six patients (33%) either were stillborn or died of disease within 2 days of birth; of the survivors, four (22%) had significant respiratory obstruction requiring surgery. Tumour location and size rather than histologic grading were the most significant features affecting the immediate clinical course. All but one of the patients who underwent early surgical resection had a favourable outcome.
Growth patterns, health and illness in preschool children from a multi‐ethnic, poor socio‐economic status municipality of Melbourne
Authors: CARMICHAEL A. , WILLIAMS H. E. , PICOT S. G.
Published: March 2008

Abstract There are little longitudinal data available for sample populations of Australian children. Previous findings from the Brunswick Family Study, unlike earlier overseas studies, have shown that adverse family and social factors were not associated with growth abnormalities. Follow‐up of 224 children from the cohort at 4 years of age has confirmed absence of significant growth disturbances, no mortality between 1 and 4 years, and serious morbidity due to organic illness in only 4% of the sample. However, 22% of the 4 year olds were found to have behaviour disturbances. These findings from a multi‐ethnic, poorer socio‐economic status population sample illustrate the importance of behaviour disturbances as one aspect of the new morbidity in Australian paediatrics and indicate that the once prevalent growth failure and organic morbidity consequent to family and social disadvantage have all but disappeared.
False negative results on newborn screening for cystic fibrosis
Authors: HENRY R.L. , BOULTON T.J.C. , RODDICK L.G.
Published: March 2008

Abstract Over a 5 year period in Newcastle, 18 new cases of cystic fibrosis (CF) ware diagnosed in children who had been screened in the newborn period. In six of these children, the screening programme failed. Four of these children had a normal screen and an additional two had elevated immunoreactive trypsin (IRT), but there were problems with the notification procedure. Three of the children missed by the screening process had a significantly delayed diagnosis; in all three cases the diagnosis of CF was suspected clinically, but a sweat test was delayed because of false reassurance from the fact that the child had been screened for CF. In a fourth case, multiple elevated sweat electrolyte levels were obtained, but the diagnosis of CF was considered to be in doubt because of the normal IRT assay. A sweat test should be performed on any child in whom there is clincial suspicion of CF.
Cell therapy: A cruel and dangerous deception. A drama in three acts
Authors: LAST P. M.
Published: March 2008

Abstract ‘Cell therapy’ is a long‐standing quack remedy used in Germany and adjacent countries. Organ extracts from fetal or young animals, fresh or lyophilized, are injected, with the intention of achieving ‘cure’ or at least ‘treatment’ of postulated organ deficiencies or failures. In Germany and in Australia ‘cell therapy’ has been administered in Down syndrome, cancer and for traumatic and other brain injuries. The preparation is banned in Germany, and can be lawfully imported into Australia only with express Ministerial permission. Even so its illicit use has been widespread. Morbidity and mortality have been reported since 1956, mostly in the German literature. There is a finite risk of infection with slow viruses of animal origin. This possibility should be considered in otherwise unexplained spongiform encephalopathy or leuco‐encephalitis. Legal problems are considerable when quack practitioners (medically qualified or otherwise) administer such a preparation to children or legally incompetent adults.