bluuebunny/crossref_metadata_2025 huggingface dataset:
A 12‐year experience of retinopathy of prematurity in infants ≤28 weeks gestation or ≤1000g birthweight
Authors: YU V. Y. H. , LIM C. T. , DOWNE L. M.
Published: March 2008

Abstract This study reported the prevalence and severity of retinopathy of prematurity (ROP) in ≤28 weeks gestation or ≤1000g birthweight infants over a 12‐year period. Among 328 survivors of ≤28 weeks gestation, 30% had ROP, 12% had severe ROP of Stage 3 or worse, 5% had at least one blind eye and 3% were bilaterally blind. Among 201 survivors of ≤1000g birthweight, the above abnormalities were found in 40, 16, 6 and 4% respectively. In both cohorts there was a significant increase in the prevalence of ROP and severe ROP between the period 1977‐80 and 1981‐84, but the lesser increase observed between the periods 1981‐84 and 1985‐88 was not statistically significant. The rates of ROP‐induced blindness were not significantly different between the three 4‐year periods. An inverse relationship was noted between the prevalence of ROP and gestational age. The results suggest a resurgence of ROP in ≤28 weeks or ≤1000g infants, the cause of which is uncertain. In view of this trend, continued surveillance of ROP is warranted.
Neonatal Gram negative meningitis: A 10‐year review, with reference to outcome and relapse of infection
Authors: ANDERSON S. G. , GILBERT G. L.
Published: March 2008

Abstract Twenty‐four infants treated for neonatal Gram negative bacillary meningitis over a 10‐year period were reviewed to determine the mortality and incidence of complications including relapse. Nine (37.5%) infants died; two survivors had major and 13 minimal or no handicap. Five (21%) infants had a relapse of meningitis after the initial course of treatment; two of these infants had been treated with cefotaxime. The outcome did not correlate with age, sex, gestation, cerebrospinal fluid (CSF) parameters or peripheral neutrophil counts. A poor outcome was associated with thrombocytopenia, persistence of viable organisms in the CSF for more than 24 h and with seizures, particularly in infants aged 7 days or less. There were no clinical or laboratory parameters predictive of subsequent relapse and there was no apparent relationship with choice or dose of antibiotic used or duration of treatment.
A system to capture physical examination data suitable for paediatric practice
Authors: DAWSON K. P. , FINDLAY G. A.
Published: March 2008

Abstract A method is described to capture data on the physical examination of children. A personal computer with a keyboard, keypad and screen is used along with a menu driven software package. Little knowledge of computing is necessary and the system can be used to produce hard copy when a suitable printer is added. Accumulated data may be transferred to a statistical package for future analysis. The method used to capture data from children with respiratory disease, particularly acute asthma, is described here, but it is stressed that the method can be adapted easily to data collection from the results of the physical examination of any system.
Oxandrolone increases final height in Turner syndrome
Authors: CROCK P. , WERTHER G. A. , WETTENHALL H. N. B.
Published: March 2008

Abstract In order to examine whether the anabolic steroid oxandrolone has any long‐term effect on height in Turner syndrome, the short‐ and long‐term effects were studied in a group of 35 individuals with the syndrome. At commencement of treatment, age range was 8.2–16 years (mean 12.9); oxandrolone dosage was 0.07‐0.26 mg/kg per day (mean 0.14 mg/kg per day) and continued for 12 months‐6 years (mean 33 months), ending at 12–18.5 years (mean 15.6 years). Height velocity increased significantly on therapy from 3.3 ± 0.1 to 5.8 ± 0.3 cm/year at 6 and 12 months, and maintained at 4.8 ± 0.3 cm/year by two years (all P<0.001). Girls who were younger and whose bone age was delayed grew faster (P<0.001). Oxandrolone dose correlated with height velocity at 12 (r= 0.39, P<0.05) and 18 months (r= 0.31, P<0.05). Both height standard deviation score (SDS) and estimated mature height (EMH) increased significantly by the end of treatment (‐0.31 ± 0.2, and to 0.45 ± 0.2, and 140.4 ± 1.1 cm to 144.4 ± 1.1 cm respectively (both P<0.0001). in 23 patients who had completed growth at a mean age of 20.6 ± 0.83 years, final height was 145.5 ± 1.3 cm. This was not significantly different from EMH of 144.9 ± 1.3 cm at the end of therapy, and based on a pre‐treatment EMH of 140.5 ± 1.3 cm, represented a mean height gain of 5 cm. Furthermore, based on height SDS for Turner syndrome at age 18 of 0.2 ± 0.2, compared with pre‐treatment height SDS of ‐0.32 ± 0.2, there was an increased SDS by the end of therapy of 0.5, equivalent to 4–5 cm. Side effects of oxandrolone were minor and infrequent, limited to increased muscularity and some degree of voice deepening. It is concluded that in Turner syndrome use of the anabolic steroid oxandrolone: (i) increases height velocity for up to 2 years of treatment; (ii) increases final height by 4–5 cm, based on both bone age EMH prediction and use of height standard deviation scores; (iii) is associated with reliable prediction of final height at end of therapy using Greulich‐Pyle/ayley‐Pinneau methods. Oxandrolone is an effective, economic, safe and well‐tolerated promoter of growth in Turner syndrome.
Pseudohermaphroditism, glomerulopathy and Wilms' tumour (Drash syndrome): A case report
Authors: HUTSON J. M. , WERTHER G.
Published: March 2008

Abstract A baby with ambiguous genitalia and 46XY chromosomes was raised as a female. Sudden and unexpected death at 11 months of age led to a post‐mortem diagnosis of Drash syndrome.
Nutritional assessment of children with juvenile chronic arthritis
Authors: MORTENSEN A. L. , ALLEN J. R. , ALLEN R. C.
Published: March 2008

Abstract Nutritional assessment was performed in 38 children with juvenile chronic arthritis (polyarticular [15]; pauciarticular [13]; systemic [10]). This included anthropometric measurements (height weight, mid‐upper arm circumference and four skinfolds) and a 7 day weighed food record. The children were classified according to current type of arthritis which in some cases was not the same as the initial onset type. Mean height Z scores were significantly below the Z score population mean of O in the systemic (P= 0.02) and polyarticular (P= 0.009) groups. Mean weight Z scores were also below the mean in the polyarticular group (P= 0.001) but the systemic group did not reach significance. Mean energy intakes were significantly below the recommended dietary intake (RDI) in the systemic (P= 0.01) and polyarticular (P= 0.001) groups. Mean intakes of calcium and zinc were below the RDI of 100% in the polyarticular group. (P= 0.0001). Thirteen (34%) of children were taking some form of self‐prescribed vitamin and/or mineral supplement Vitamin C was the most commonly used supplement, despite dietary intakes greatly exceeding the RDI. Nutritional assessment is essential in the management of patients with JCA, in particular those with systemic or polyarticular disease.
The gut, motility and manometry
Authors: CATTO‐SMITH A. G.
Published: March 2008

Many diseases in childhood present with symptoms resulting from the effects of those diseases on gut motility, including vomiting, colicky abdominal pain, ileus, constipation or diarrhoea. The control of gastrointestinal motility has been the subject of intensive research. It is now recognized that motility in the gastrointestinal tract is influenced by a complex range of factors, not only involving intestinal musculature, but also neural and humoral control. The development of techniques to measure motor activity in the gastrointestinal tract has increased our understanding of the pathophysiology of motor disorders. Manometric techniques are now available to study motility in pharynx, oesophagus, stomach, the biliary tract small and large intestine, and anorectum.

The following discussion provides a background to the use of manometry in the study of motor disorders affecting the gut and will focus on the oesophagus and anorectum.
Management of pain in the newborn infant
Authors: COLDITZ P. B.
Published: March 2008

The importance of providing adequate analgesia for children in pain was highlighted by a recent annotation in this journal.1 Newborn infants as well as children fare better after surgery if adequate analgesia is provided.2 The sick newborn infant who has not had surgery but who is receiving assisted ventilation and multiple invasive procedures may also fare better with analgesia, but this topic has received little attention despite the large number of babies who receive this treatment in newborn intensive care units. This manuscript reviews the evidence of what constitutes a ‘painful’ stimulus to a newborn infant and details options for analgesic treatment. Some issues are raised that may dictate the direction of necessary future research.
Glucose: A fuel for thought!
Authors: AYNSLEY‐GREEN A.
Published: March 2008

It is a privilege and an honour to deliver this, the Turner Gibson Oration for 1989. I chose the title of my lecture because glucose, as the essential substrate for brain function, is indeed the fuel for our thoughts. Although important at all ages, it has a particular significanice for the young child, since a normal supply of glucose is essential to protect brain development and hence the potential for thought in the child's brain. Thus, glucose should have a high priority in our own thinking as paediatricians. With this in mind, the purpose of my lecture is to fuel your own thoughts on your management of children who have disordered glucose homeostasis by examining controversy, challenging current dogma and providing new information.
Volumetric diffusive respirator use in neonatal respiratory failure
Authors: CAMPBELL P. J. , CHILTON H. W. , GARVEY P. A. , GUPTA† J. M.
Published: March 2008

Six very low birthweight neonates with terminal respiratory failure due to severe hyalline membrane disease who failed to respond to conventional ventilation were offered a trial of high frequency jet ventilation using the volumetric diffusive respirator (VDR). All neonates showed improvement in pulmonary function. Two neonates were weaned successfully from high frequency ventilation. The results of this initial trial suggest that the volumetric diffusive respirator is a safe and effective method of ventilation in neonates with respiratory failure and that the survival rate in such neonates might be enhanced if treatment is introduced earlier in the disease.
Bronchopulmonary dysplasia in very low birthweight infants
Authors: YIP Y. Y. , TAN K. L.
Published: March 2008

The incidence, clinical presentation and severity of bronchopulmonary dysplasia (BPD) in 110 consecutive very low birthweight (VLBW) infants admitted to the National University Hospital Neonatal Intensive Care Unit between October 1985 and January 1989 is reviewed. Thirty‐two infants died, giving an overall survival rate of 70.90%. Sixty infants (54.4%) required mechanical ventilation in the first week of life; 24 (40%) of these infants died. Of the 36 survivors, 23 required oxygenation at 28 days of life and 21 fulfilled the criteria for BPD (35% of the 60 ventilated and 58% of the survivors). The incidence of BPD in all VLBW infants is 19% and of VLBW survivors 27%. Birthweight and gestational age appear to be important determinants. All the survivors in the 501‐750 g birthweight group developed BPD compared to 6.25% in those above 1250 g. None of those >30 weeks gestation developed BPD.

Two forms of BPD were observed; the ‘severe’ group presented radiologically with chest radiographs characteristic of Stage IV BPD, while the ‘mild’ group with small or normal sized lungs demonstrated irregular strands of radio‐densities alternating with areas of normal or increased lucency. The duration of mechanical ventilation and oxygen dependency were significantly longer in the ‘severe’ group, with the mean maximum peak inspiratory pressure, mean airway pressure, and Fio2 required in the first week of life being also significantly higher.

Hyaline membrane disease was the main cause of respiratory failure requiring ventilation. The other causes were persistent pulmonary hypertension (1) and apnoea of prematurity (3); all of the latter developed only mild BPD.

Those who developed BPD required a significantly longer period of hospitalization, a longer period to regain their birthweight and attain a weight of 2 kg, and a higher incidence of retinopathy of prematurity compared with those without BPD even after correcting for the earlier gestational age of the BPD group.
Second intracranial neoplasms following treatment of childhood acute lymphoblastic leukaemia
Authors: VOWELS M. R. , TOBIAS V. , MAMEGHAN H.
Published: March 2008

We report a boy with acute lymphoblastic leukaemia (ALL) treated with chemotherapy and prophylactic cranial irradiation to a dose of 24 Gy. Six years after diagnosis he developed a glioma and died. Prior to 1979, four cases of second malignant neoplasm (SMN) of the brain had been reported in children treated for ALL. These SMNs occurred within 2 years of the original diagnosis (median 1.3 years) and at least two of four patients had not received prior radiotherapy. Since 1979. 28 cases of SMN of the brain have been reported including nine of 468 (1.9%) long‐term survivors in one study. All occurred more than 3.7 years from diagnosis (median 6.5 years; range 4‐13 years) and all received cranial irradiation (median 24 Gy; range 20‐48 Gy). These data indicate a change in the pattern of SMNs which is most likely due to the introduction of cranial irradiation. As well, the frequency of SMNs in children treated for ALL appears to have increased, although it is still no greater than the risk of SMNs developing following the treatment of any other primary childhood neoplasm.
Infantile hepatic haemangioma: Investigation and treatment
Authors: KRISTIDIS P. , DE SILVA M. , HOWMAN‐GILES R. , GASKIN K. J.
Published: March 2008

Infantile hepatic haemangiomas are benign tumours which tend to regress in late infancy. We describe five infants with hepatic haemangioma, three of whom developed congestive cardiac failure. Technetium‐99m labelled red blood cell scan was useful in the diagnosis and follow‐up of the lesion. The three symptomatic infants were treated with prednisone (2 mg/kg per day) for 2 months in addition to digoxin and diuretics. Significant clinical improvement occurred within 3 weeks in each case. We conclude that the red blood cell scan is a good non‐invasive diagnostic test and recommend corticosteroids as initial management for symptomatic infantile hepatic haemangiomas.
Near miss sudden death in an infant with Wolff‐Parkinson‐White syndrome
Authors: ROSENBERG H. C. , YEE R. , SHARMA A. D. , GOLDBACH M. M. , GUIRAUDON G. M. , LI M. D.
Published: March 2008

A 6 month old infant with known Wolff–Parkinson–White syndrome presented with an out of hospital cardiac arrest. An electrocardiogram in the emergency department demonstrated atrial fibrillation with rapid ventricular response. The child subsequently was resuscitated and underwent successful interruption of an accessory connection after failing medical therapy. This case underlines the need to reassess the indications for invasive electrophysiologic testing in young children.
Anthropometry and obesity in myelomeningocele
Authors: ROBERTS D. , SHEPHERD R.W. , SHEPHERD K.
Published: March 2008

Anthropometric data on 110 myelomeningocele (MMC) subjects in relation to age, sex, level of lesion and ambulation were studied to investigate growth and the occurrence of obesity in MMC. In 52 subjects, indices of obesity were validated against body composition analysis of total body fat (%BF) using body potassium and body water techniques. Most subjects were short and light compared to reference data and became relatively shorter and heavier with age. Overall trunk growth was not affected by the level of lesion, but sitting height was affected by kyphoscoliosis. Arm spans were similar to reference data, but were significantly greater in wheelchair users. Leg length was greatest in those who walked. Body composition data showed excess adipose in many MMC subjects, this tendency increasing with age. When correlated with %BF determined from body composition analysis, common clinical indices of obesity had variable r values (wt/ht2 0.78; wt/sitting ht2 0.77; upper arm fat area 0.75; triceps skinfold 0.74; wt/arm span2 0.68, with the 4 skinfold method correlating best, 0.82). Anthropometric measures, taken with cognizance of level of disability and mobility, can accurately assess body growth and the occurrence of obesity in MMC. The influence of ambulatory activity in promoting normal growth is emphasized.
The effect of dexamethasone upon platelets and neutrophils of preterm infants with chronic lung disease
Authors: BOURCHIER D. , WESTON P. J.
Published: March 2008

The effect of a 21‐day (reducing dose) course of dexamethasone upon platelet numbers, neutrophil numbers and neutrophil morphology in ventilator‐dependent preterm infants with chronic lung disease is reported. Forty‐one infants, who were sespsis‐free throughout the treatment period, received 46 courses of dexamethasone. In these infants the circulating platelet count increased significantly from 235 ± 157 to 476 ± 208 × 109/L Both total neutrophil numbers (7.94 ± 7.16 to 19.56 ± 12.40 × 109/L) and immature neutrophil numbers (1.19 ± 1.22 to 2.68 ± 2.58 × 109/L) also showed a significant increase reaching a peak on day 7 of treatment and decreasing thereafter. The immature: total (I:T) neutrophil ratio remained essentially unchanged. Eight other infants who developed serious sepsis during the treatment period showed a fall in both platelets (293 ± 236 to 140 ± 170 × 109/L) and total neutrophil numbers (18.61 ± 10.83 to 15.76 ± 10.53 × 109/L), together with an increase in immature neutrophils (2.30 ± 2.80 to 8.22 ± 13.91 × 109/L) and consequent increase in I:T ratio.
Three cases of congenital adrenal hypoplasia: A cause of salt‐wasting and mortality in the neonatal period
Authors: BATCH J. A. , MONTALTO J. , YONG A. B. W. , GOLD H. , GOSS P. , WARNE G. L.
Published: March 2008

Three infants with congenital adrenal hypoplasia are described. The two surviving infants were detected and successfully treated in the neonatal period due to a suggestive family history (Case 1) and antenatal maternal oestriol screening (Case 2). The modes of inheritance, diverse clinical presentation, associated conditions, diagnostic work‐up and pathology of congenital adrenal hypoplasia in these three infants is discussed.
Conductive Education
Authors: REDDIHOUGH D.
Published: March 2008

Over the past 5 years, there has been increasing interest in the application of principles of Conductive Education, also known as the Peto method, to treat children with cerebral palsy. In 1945 Andras Peto, a Hungarian physician trained in rehabilitation and psychiatry, began his work with motor disordered children.1 In 1952 he opened what was then called the National Motor Therapy Institute in Budapest. By 1963 his work had achieved national recognition. When he died in 1967 his pupil, Dr Mari Hari, continued his work and became director of the Institute, now known as the Andras Peto Institute for Motor Disorders.
Aluminium absorption in infancy
Authors: CHEDID F. , FUDGE A. , TEUBNER J. , JAMES S. L. , SIMMER K.
Published: March 2008

The use of aluminium‐containing medications and aluminium contamination of infant formulae is common. We aimed to determine whether aluminium absorption occurs after antacid ingestion. Plasma and urinary levels of aluminium were measured before and after antacid therapy in seven infants whose mean gestational age was 36 ± 2 weeks and postnatal age 11 ± 5 days. Antacid therapy (400‐800 μmol aluminium) was given with feeds for 2 days.

Plasma aluminium levels increased and reached toxic levels (0.64 ± 0.33 μmol/L vs 3.48 ± 2.86 μmol/L, P= 0.029). Urinary aluminium: creatinine ratio also increased. These results demonstrate that infants absorb aluminium from antacids and raise the concern of aluminium toxicity.
Delivery of Vitamin A from parenteral nutrition solutions in neonates
Authors: THOMAS D. G. , JAMES S. L. , FUDGE A. , ODGERS C. , TEUBNER J. , SIMMER K.
Published: March 2008

The delivery of Vitamin A from parenteral nutrition may be suboptimal. To Investigate this sample solutions were prepared and Vitamins A and E concentrations from the solution bags and the efflux from the lines were measured over a 24 h period. The results show that mean Vitamin A levels in the solution bags declined from a range of 57‐66% to 17% of expected over 24 h and at the efflux of the lines from a range of 13‐29% to 4% of expected, giving a calculated delivery of 10% of expected. There is no improvement with light protection or an ethylene vinyl acetate system. Mixing the vitamin preparation in lipid showed less decline (from 92 to 70% of expected over 24 h), but the delivery was variable. When vitamins were added to a lipid‐dextrose‐amino acid solution, there was minimal loss from the solution bag and line with a calculated delivery of 94% of expected. The delivery of Vitamin E from all systems was constant with a mean calculated delivery of 74% of expected.

It was concluded that the mixing of multivitamins in dextrose‐amino acid‐electrolyte solutions results in poor delivery of Vitamin A and this is improved by mixing in lipid solution. This is important in preterm infants who are prone to become Vitamin A deficient.
The natural history of untreated phenylketonuria over 20 years
Authors: PITT D. B. , DANKS D. M.
Published: March 2008

Fifty‐one adult with untreated phenylketonuria (PKU), have been reviewed after a 20 year interval, at ages ranging from 28.8 to 71.8 years. Five died of causes unrelated to PKU. Three severely affected individuals had shown a progressive loss of motor function and three had developed epilepsy, bringing the total with this problem to 12. No loss of abilities was apparent in 41 patients. Other health problems, including cataracts, were not frequent. Serum phenylalanine levels had decreased over the 20 year period. Untreated PKU does not generally cause progressive loss of abilities during adult life.
Reduced mortality in small premature infants treated at birth with a single dose of synthetic surfactant
Authors: CORBET A. J. , LONG W. A. , MURPHY D. J. , GARCIA‐PRATS J. A. , LOMBARDY L. R. , WOLD D. E.
Published: March 2008

A randomized controlled trial of Exosurf® Neonatal, a synthetic exogenous surfactant, was performed. Exosurf was given to premature infants weighing 700‐1350 g, by instillation down the endotracheal tube during mechanical ventilation, within 1 h of birth. Control infants were treated with air. Dose administration was performed in secrecy by clinicians who maintained the blind for 2 years. A total of 109 infants received air and 109 received Exosurf; 19 infants with congenital pneumonia or major malformations were excluded from the primary efficacy analysis. By the age of 28 days there were 14 deaths in the air group and 4 deaths in the Exosurf group, a 69% reduction with Exosurf (P= 0.050). Survival without bronchopulmonary dysplasia at the age of 28 days was significantly improved by 15% (P= 0.050). By the age of 1 year post‐term there were 19 deaths in the air group and 10 deaths in the Exosurf group, a 42% reduction with Exosurf (P = 0.104). There were no significant changes in the incidence of bronchopulmonary dysplasia, pulmonary air leaks, intraventricular haemorrhage, patent ductus arteriosus, necrotizing enterocolitis or infection. The reduction in mortality indicates important results in high risk premature infants treated soon after birth with a single dose of Exosurf.
Fundoplication in preterm infants with gastro‐oesophageal reflux
Authors: JUSTO R. N. , GRAY P. H.
Published: March 2008

Gastro‐oesophageal reflux in preterm infants may result in recurrent pulmonary insult due to aspiration of gastric contents, and intractable obstructive apnoea. Fundoplication is effective in controlling reflux when medical management has failed. Our experience between 1981 and 1990 was reviewed to assess the efficacy of early surgery in the management of 11 such infants. The infants had a median gestational age of 29 weeks and a median birthweight of 1032g. Nine infants had fundoplication for recurrent aspiration pneumonitis and two for intractable apnoea. The median age at the time of surgery was 100 days and the median weight of the infants was 2640 g. Nine infants were oxygen dependent and two were still ventilated at the time of surgery. The operative procedure was well tolerated by 10 of the 11 infants. Surgery failed to control reflux in two infants, although good control was obtained in the one who had subsequent surgery. Three infants required prolonged ventilation postoperatively; two of them died later from pulmonary failure. The median time to discharge was 24 days (8‐113 days). All infants with intractable apnoea were cured by surgery. Fundoplication is an effective method of management when used early in the treatment of chronic gastro‐oesophageal reflux in preterm infants. There is minimal morbidity from the surgical procedure.
Survival, growth and quality of life in children after orthotopic liver transplantation: A 5 year experience
Authors: CHIN S. E. , SHEPHERD R. W. , CLEGHORN G. J. , PATRICK M. K. , JAVORSKY G. , FRANGOULIS E. , ONG T. H. , BALDERSON G. , KOIDO Y. , MATSUNAMI H. , LYNCH S. V. , STRONG R.
Published: March 2008

The aims of this study were to investigate outcome and to evaluate areas of potential ongoing concern after orthotopic liver transplantation (OLT) in children. Actuarial survival in relation to age and degree of undernutrition at the time of OLT was evaluated in 53 children (age 0.58‐14.2 years) undergoing OLT for endstage liver disease. Follow‐up studies of growth and quality of life were undertaken in those with a minimum follow‐up period of 12 months (n= 26). The overall 3 year actuarial survival was 70%. Survival rates did not differ between age groups (actuarial 2 year survival for ages <1,1‐5 and >5 years were 70, 70 and 69% respectively) but did differ according to nutritional status at OLT (actuarial 2 year survival for children with Z scores for weight <−1 was 57%, >−1 was 95%; P=0.004). Significant catch‐up weight gain was observed by 18 months post‐transplant, while height improved less rapidly. Quality of life (assessed by Vineland Adaptive Behaviour Scales incorporating socialization, daily living skills, communication and motor skills) was good (mean composite score 91±19). All school‐aged children except one were attending normal school. Two children had mild to moderate intellectual handicap related to post‐operative intracerebral complications. Satisfactory long‐term survival can be achieved after OLT in children regardless of age but the importance of pre‐operative nutrition is emphasized. Survivors have an excellent chance of a good quality of life and of satisfactory catch‐up weight gain and growth.
Ioxaglate in paediatric angiocardiography
Authors: OGLE G. D. , SWINBURN M. J. , McCREDIE R. M.
Published: March 2008

Abstract  It is generally agreed that low osmolar contrast media are better tolerated than conventional media. This study examined both tolerance and image quality of ioxaglate in a group of paediatric patients undergoing angiocardiography for congenital heart disease. A consecutive series of 50 patients (mean age 5.47 years; range 4 days‐14 years) were examined. The mean dose of ioxaglate administered per patient was 2.93 mL/kg. In general, ioxoglate was well tolerated. Three patients became febrile and another developed eosinophilia. Serum creatinine rose by a mean of 10 μmol/L. Significant renal dysfunction occurred in 12 patients with an increase in creatinine of 20–30 μmol/L. In no patient, however, were these effects a significant clinical problem. Diagnostic image quality was generally considered to be good with both cine‐angiography and digital subtraction angiographic techniques.
Malnutrition in children with chronic liver disease accepted for liver transplantation: Clinical profile and effect on outcome
Authors: SHEPHERD R. W. , CHIN S. E. , CLEGHORN G. J. , PATRICK M. , ONG T. H. , LYNCH S. V. , BALDERSON G. , STRONG R.
Published: March 2008

Abstract  The nutritional profiles of 37 children (aged 0.5–14.0 years) with chronic liver disease at the time of acceptance for orthotopic liver transplantation (OLTP) have been evaluated using clinical, biochemical and body composition methods. Nutritional progress while waiting for a donor has been related to outcome, whether transplanted or not. At the time of acceptance, most children were underweight (mean standard deviation (s.d.) weight = 1.4±0.2) and stunted (mean s.d. height = ‐ 2.2±0.4), had low serum albumin (27/35) and had reduced body fat and depleted body cell mass (measured by total body potassium ‐ mean % expected for age = 58±5%, n= 15). Mean ad libitum nutrient intake was 63±5% of recommended daily intake (RDI). Those who died while waiting (n= 8) had significantly lower mean initial s.d. weight compared with those transplanted. The overall actuarial 1 year survival of those who were transplanted (mean waiting time = 75 days) was 81% but those who were initially well nourished (s.d. weight > ‐ 1.0) had an actuarial 1 year survival of 100%. There were no significant differences in actuarial survival in relationship to age, type of transplant (whole liver or segmental), liver biochemistry or the presence or absence of ascites. Of the total group accepted for OLTP, whether transplanted or not, the overall 1 year survival for those who were relatively well nourished was 88% and for those undernourished (initial s.d. weight > ‐ 1.0) was 38% (P<0.003). Declining nutritional status during the waiting period also adversely affected outcome. We conclude that malnutrition and/or declining nutritional status is a major factor adversely affecting survival in children awaiting OLTP. In transplant units where waiting time is greater than 40 days, earlier referral, prioritization of cases and the use of adult donor livers may reduce this risk and efforts to maintain or improve nutritional status deserve further study.
Benign intracranial hypertension in childhood: A review of 23 patients
Authors: DHIRAVIBULYA K. , OUVRIER R. , JOHNSTON I. , PROCOPIS P. , ANTONY J.
Published: March 2008

Abstract  Twenty‐three patients with benign intracranial hypertension (BIH) were seen at the Royal Alexandra Hospital for Children, Sydney over an 18 year period to 1988. Age at presentation ranged from 6 months to 13 years and 5 months. The female to male ratio was 2.3: 1. The aetiological factors (sometimes multiple) included: chronic middle ear infection, 30%; dural sinus thrombosis, 22%; head injury, 13% Vitamin A overdosage, 4%; tetracycline exposure, 4%; and no apparent cause, 43%. Headache was the most common presenting symptom occurring in 91% of patients, followed by vomiting in 65% and blurred or double vision in 57%. Papilloedema occurred in 96% of patients, abducens palsy was noted in 48% and visual impairment in 45%. All patients improved clinically after treatment, one with lumbar puncture only. Of 17 patients treated with steroids, 10 patients recovered and seven patients went on to lumboperitoneal shunt. Two patients recovered with steroid and diuretic treatment. Of two patients initially treated with diuretics only, one recovered and one subsequently required a shunt. Only one patient was initially treated with a lumboperitoneal shunt. Three of the shunted patients had shunt block requiring revision. None had permanent visual loss or other significant sequelae.

The visual prognosis of BIH in childhood is good. In view of the relatively high complication rate of steroids and shunting, a controlled comparison of steroid vs acetazolamide/diuretic therapy should be undertaken.
Plant cardiac glycosides and digoxin Fab antibody
Authors: CHEUNG K. , URECH R. , TAYLOR L. , DUFFY P. , RADFORD D.
Published: March 2008

Abstract  The potential application of the Digoxin Fab antibody (Wellcome Digibind) in the clinical management of plant poisoning was investigated. The cardiac glycoside contents of various Australian plants were studied using immunoassay techniques. The cross‐reactions of the Fab antibody and two digoxin assay antibodies against extracts of these plants were also studied. Results obtained indicated that the Digibind antibody cross‐reacted with a wide range of glycosides contained in Australian plants and therefore could be of use in the treatment of life‐threatening plant poisoning.
A profile of respiratory symptoms in urban and rural South Australian school children
Authors: CROCKETT A. J. , ALPERS J. H.
Published: March 2008

Abstract This report describes the cross‐sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.
Necrotizing enterocolitis in a perinatal centre
Authors: LUI K. , NAIR A. , GILES W. , MORRIS J. , JOHN E.
Published: March 2008

Abstract Thirty‐five neonates developed radiologically proven necrotizing enterocolitis (NEC) over a 40 month period. They were 28∖pm2 weeks gestation, and weighed 1094∖pm411 g at birth. Eighteen infants (51%) required surgery and three (8.5%) died. The incidence was 6.7% in the very low birthweight (VLBW) infants. A large proportion of NEC (60%) presented beyond 10 days of life. An inverse relationship between gestation and age of onset was observed. The age of presentation was 22 ∖pm 13 days (range 10–53 days) for the 18 infants 28 weeks compared with 7 ∖pm 5 days for those over 28 weeks (P<0.01). Five NEC infants had bacteraemia which occurred 2–7 days prior to gastrointestinal symptoms of NEC, and four were staphylococcal. Compared with infants controlled for gestation, there was no significant differences observed in perinatal events or feeding history. We concluded that an immature gastrointestinal system is vulnerable to NEC even beyond the early neonatal period.
Thyrotrophin‐blocking antibodies in congenital hypothyroidism
Authors: KUNG A. W. C. , LOW L. C. K.
Published: March 2008

Abstract The role of transplacental transfer of maternal thyrotrophin (TSH)‐blocking antibodies causing congenital hypothyroidism in Southern Chinese children was examined in this study. Twenty‐two mothers of 24 patients with congenital hypothyroidism were studied 3–5 years after delivery. None of them had thyroid dysfunction at delivery or at the time of study. None had antithyroglobulin or antimicrosomal antibody. Only one mother was found to have TSH‐binding inhibitory immunoglobulin (TBII), and her child had agenesis of the thyroid. This women had Graves disease in remission for 2 years before delivery. None had TSH‐stimulated cAMP response inhibitory immunoglobulin (TSII). Ten of the 24 congenital hypothyroid children had transient neonatal hypothyroidism, seven had agenesis of the thyroid, six had dyshormonogenesis and one had a sublingual thyroid. As none of the mothers who had children with transient neonatal hypothyroidism had blocking antibodies at the time of study, the aetiology of the transient neonatal hypothyroidism remains unclear. These data suggest that maternal TSH‐blocking antibodies do not play a role in most cases of sporadic congenital hypothyroidism.
Severity of rotavirus infection in relation to serotype, monotype and electropherotype
Authors: BARNES G. L. , UNICOMB L. , BISHOP R. F.
Published: March 2008

Abstract The aim of this study was to determine whether the severity of symptoms associated with rotavirus infection was related to the serotype of the infecting virus. Severity of clinical symptoms in 108 children admitted to hospital for treatment of rotavirus diarrhoea was retrospectively assessed using a scoring system for frequency and duration of vomiting and diarrhoea, degree of fever, acidosis and dehydration, and presence of electrolyte imbalance. Children were 6–30 months old and were fully weaned at onset of symptoms prior to admission to hospital. No other enteric pathogens were detected during the course of the illness. Serotypes and monotypes were identified using a panel of monoclonal antibodies. Gel electrophoresis of rotavirus RNA was performed to determine electropherotypes. Children surveyed were infected with serotype 1 (47), serotype 2 (15) or serotype 4 (46) rotaviruses. Comparisons of severity of clinical symptoms according to infecting serotype revealed no statistically significant differences between serotype 1,2 or 4 infections. In addition, no differences were detected between different rotavirus strains within each serotype (as judged by electropherotype) including monotypes 1a or 1c. This study failed to reveal differences in virulence between rotavirus strains of different VP7 serotypes infecting young children.
Familial occurrence of complete agenesis of the diaphragm
Authors: SRIPATHI V. , BEASLEY S. W.
Published: March 2008

ABSTRACT The tenth occurrence of complete unilateral agenesis of the diaphragm (McKusick 22240) in siblings is reported in this study. It is likely that parents of children with this type of congenital diaphragmatic hernia have a significantly increased recurrence risk for future offspring. Genetic counselling and antenatal ultrasound should be considered for subsequent pregnancies in families with a previous child with complete agenesis of the diaphragm.
Evolution of bereavement counselling in sudden infant death syndrome, neonatal death and stillbirth
Authors: THEARLE M. J. , GREGORY H.
Published: March 2008

AbstractThere have been changing attitudes to death and grief in Western society in recent centuries. During the twentieth century complex medical and social changes have resulted in changing attitudes to and experiences with death. Specifically, the impact of death in childhood is reviewed. In recent decades sudden and unexpected death associated with stillbirth, the newborn and infants appears to have a more profound affect on the bereaved parents than in the past when the overall death rates in childhood were higher. The evolution of parent support groups developed since the 1960s to alleviate the psychological trauma of unexpected and sudden death in childhood has been traced. These groups were founded initially for support with sudden infant death syndrome and later extended to include families with stillbirth and neonatal death.
Biphasic rise of serum immunoglobulins G and A and sex influence on serum immunoglobulin M in normal Chinese children
Authors: LAU Y. L. , JONES B. M. , YEUNG C. Y.
Published: March 2008

Abstract A study was conducted on 751 healthy children from child health clinics, kindergartens and schools, and 80 normal adults to establish reference ranges for serum immunoglobulins (lg) G, A and M concentrations in normal Chinese. Serum lgG, lgA and lgM concentrations were determined by nephelometry. Serum lgG and lgA were shown to have a significant rise during the preschool age as well as at puberty with a plateau phase in between. This biphasic maturation profile has not been reported in Caucasians and the reasons for the observed difference have yet to be elucidated. Serum lgM concentrations were shown to be higher in females than in males, reaching significance in most age groups beyond 4 years of age. The difference between the two sexes in Chinese was of similar magnitude as that reported for Blacks and Caucasians, that is, 30%. Our findings support the hypothesis that the human X chromosome may carry quantitative genes for lgM.
Acquired amegakaryocytic thrombocytopaenia in a child
Authors: SCARLETT J. D. , WILLIAMS N. T. , McKELLAR W. J. D.
Published: March 2008

Abstract A boy aged 5 years is described with amegakaryocytic thrombocytopaenia, which was associated with defective granulopoiesis and erythropoiesis, but did not evolve into marrow aplasia. Marrow cultures confirmed the presence of abnormalities in each of the haemopoietic lineages and identified defective maturation of megakaryocytic precursors. There was no evidence of a humoral inhibitor of megakaryopoiesis. The patient's blood cell counts responded to treatment with oxymetholone.
Antineutrophil cytoplasmic antibody and gallium lung scintiscan in usual interstitial pneumonitis
Authors: LAU Y. L. , TAM A. Y. C. , YEUNG H. W. D. , FU K. H. , LAWTON J. W. M.
Published: March 2008

Abstract A 2 year old Chinese boy was reported in whom there was an association between usual interstitial pneumonitis (UIP) and serum antineutrophil cytoplasmic antibody of the classical cytoplasmic type (cANCA). The concentration of cANCA reflected disease activity and decreased during a 6‐week course of prednisolone. The gallium lung scintiscan index correlated with his disease activity. Both the serum cANCA concentration and the gallium lung scan could be used to monitor responses to treatment in this patient with UIP.
Chronic lung disease in very low birthweight infants: A prospective population‐based study
Authors: DARLOW B. A. , HORWOOD L. J.
Published: March 2008

Abstract A prospective population‐based study of chronic lung disease among all very low birthweight infants (birthweight 500–1499 g) born in New Zealand in 1986 is reported. Of 413 of these infants admitted to neonatal units, 355 (86%) survived to 28 days. An additional 50 infants were recorded as liveborn but died in the labour ward or other place of birth. Both observed survival and survival adjusted for birthweight, gestation and gender were significantly (P<0.05) better in larger centres. Oxygen requirement was assessed at 28 days of age, 36 weeks equivalent gestation and 84 days of age, when 38.6,23.1 and 13.8% of infants, respectively, were being treated with oxygen. To examine the joint effects of predictor variables on oxygen requirement at each age, the data were analysed using multiple logistic regression methods. At 28 days, lower birthweight, shorter gestation, respiratory distress syndrome (all P<0.0001), and gender and hospital principally caring for the infant (both P<0.05) were significantly associated with treatment with oxygen. In comparison with other studies, New Zealand appears to have a relatively high rate of chronic lung disease. We speculate that a contributing factor may be the small size of some regional neonatal units.
Cardiac tamponade from a fine silastic central venous catheter in a premature infant
Authors: AIKEN G. , PORTEOUS L. , TRACY M. , RICHARDSON V.
Published: March 2008

Abstract A 790 g infant developed cardiac tamponade 17 h after starting parenteral nutrition through a fine silastic catheter, the tip of which was accidentally positioned against the wall of the right atrium. Cold light examination suggested the diagnosis and pericardial aspiration of clear fluid with a high glucose content restored the circulation.
Homozygous pyruvate kinase deficiency in Hong Kong ethnic minorities
Authors: WEI D. C. , CHAN L. C. , LI A.
Published: March 2008

Abstract Three cases of pyruvate kinase (PK) deficiency resulting in congenital haemolytic anaemia with transfusion dependency are described. These cases resulted from consanguineous marriages in non‐Han Chinese and include a pair of twins. We believe this to be the first documentation of homozygous PK deficiency in the Hong Kong population. The diagnosis was masked due to transfusion dependency in each case stressing the need to take a sample of pretransfusion blood for PK enzyme assay, and for family studies, when this disorder is suspected.
Using a computer database to record and evaluate a school screening service
Authors: BLICK B. , REZNIK R. , BECKENHAM W. , ZILIBOWITZ M.
Published: March 2008

Abstract School screening has been taking place in New South Wales since 1907. The need for better monitoring of the school health service to determine the outcome of the screening process has been advocated frequently. This paper reports on the development of a computerized surveillance system which allows school screening to be evaluated on an ongoing basis. The results of the first year's use of the programme on a study population of children first screened in 1989 in a northern metropolitan area of Sydney demonstrate that the system is practical and effective when used by people with little or no prior computer knowledge. It plays a role in both improving follow‐up of the screening process and the assessment of the service. The prevalence rate of new defects found was four per 100 children screened. Issues raised about the screening process from the data collected are also discussed.
Health problems and health checks in school‐aged children with Down syndrome
Authors: SELIKOWITZ M.
Published: March 2008

Abstract A survey by parent questionnaire and interview was carried out to determine the frequency of health problems in 204 children with Down syndrome. Seventy‐two children (35.3%) had a congenital heart defect. Refraction had been performed on 196 and 68 (34.6%) of these had a refractive error. A diagnosis of ‘glue ear’ had been made in 112 (54.9%) and in 12 (11%) of these permanent hearing loss was present. Significant ill‐health over the previous 12 months consisted of cardiac failure (two children), more than three upper respiratory tract infections (24 children), bronchitis (eight children), pneumonia (two children) and asthma (seven children). A neck X‐ray had been performed in 172 (84.3%) and had demonstrated the presence of atlanto‐axial instability in 12 (7%) of these. One hundred and thirty‐two (64.7%) of the children had been tested for hypothyroidism in the previous 18 months and this had been found in four (3%) of these children. The implications of these and other findings are discussed in relation to parental counselling and planning of routine health checks.
Motorcycling attitudes and behaviours. II. 14 and 15 year old adolescents
Authors: REEDER A. I. , CHALMERS D. J. , LANGLEY J. D. , BEGG D. J.
Published: March 2008

Abstract Of 846 adolescents interviewed near their 15th birthday, 51% could drive a motorcycle. A further 13% intended to learn. Drivers reported friends (mean age 16.5 years) as the most common source of instruction. Forty‐four per cent of drivers and 69% of intending learners planned to apply for licences. Thirty‐five per cent of the sample had driven or ridden as passengers on a motorcycle on‐road in the past year and 85% of these had worn a helmet on the last occasion. The commonest cause of injuries to motorcyclists resulting in hospitalization (lower limb injury) was correctly identified by 52% of the sample. Fear of injury was the reason given for not learning to ride by 55% of confirmed non‐drivers. Fifteen medically treated motorcycling injuries were reported for a 2‐year recall period. Females reported significantly less exposure and less use of protective clothing than males. The issues of initiation, training, constraints on use and preventive strategies are discussed.
Citrobacter freundii septic arthritis
Authors: BRUEHL C. L. , LISTERNICK R.
Published: March 2008

Abstract Septic arthritis in an 8 month old infant due to Citrobacter freundii was treated successfully with a third generation cephalosporin. Infections due to Citrobacter are uncommon in this age group and are almost unknown as a cause of septic arthritis.