bluuebunny/crossref_metadata_2025 huggingface dataset:
Accidental poisoning in the first three years of life
Authors: BEAUTRAIS A.L. , FERGUSSON D. M. , SHANNON F. T.
Published: March 2008

ABSTRACT. The incidence of accidental poisoning was examined prospectively in a birth cohort of 1124 children.

Nineteen percent of children had at least one incident of poisoning or suspected poisoning by the age of three years.

No medical treatment was sought for 33.5% of poisoning incidents and of those poisonings for which treatment was sought, only two cases required management beyond observation, induced vomiting or gastric lavage.

The most frequent sources of poisoning were medicines, household cleansers and petrochemicals.

Poisoning occurred more frequently in children of young mothers; children who entered single parent families at birth; children whose mothers reported a large number of problems with the child; children from homes reporting a large number of life events and stresses; children from homes where parental separation had occurred; children from families who made multiple changes of residence and in children whose mothers had been prescribed tranquillisers and/or antidepressant medication. Logistic regression analysis showed that the strongest predictors of poisoning were the mother's reports of problems with her child and the mother's use of tranquillisers and/or antidepressant medication.
Tracheopexy — aorto‐tracheal suspension for severe tracheomalacia
Authors: COHEN DOUGLAS
Published: March 2008

ABSTRACT. This paper describes the tracheomalacia seen in two groups of children: in association with tracheo‐oesophageal fistula, and in so‐called “innominate artery compression”. The underlying cause in both groups is believed to be related to malformation and deficiency in the cartilage of the tracheal wall, with an increase in the width of the membranous trachea. Symptoms in tracheomalacia range from mild to severe. Indications for surgery are “reflex apnoea”, severe respiratory obstruction, or severe and repeated respiratory infections with retention of sputum and cyanotic attacks. Endoscopy is essential to confirm the cause, and the need for surgery. The operative technique of aorto‐tracheal suspension is described, and the results in 20 patients submitted to tracheopexy since January 1969 are reported.
Postneonatal mortality in Western Australia 1970–78
Authors: READ ANNE , STANLEY FIONA
Published: March 2008

ABSTRACT. Postneonatal deaths in Western Australia from 1970–78 were studied using a linked file of birth and death registrations. Postneonatal mortality fell during the period under study. The fall occurred in both male and female rates and the former were higher than the latter in all years. The infants at high risk during the postneonatal period were those born to unmarried teenage mothers residing in rural areas, especially if the infants were of low birthweight (<2500g). Multiple births and those infants born to mothers whose previous issues were over 4 were also at high risk. Infants born to Aboriginal mothers experienced a significantly higher rate of postneonatal mortality than those born to non‐Aboriginal mothers. However, a significant improvement in the Aboriginal rate occurred between 1976 and 1977. The major causes of postneonatal death were sudden infant death syndrome, infections and congenital abnormalities.
Long‐term follow‐up records
Authors: SOUTHBY ROBERT
Published: March 2008

ABSTRACT. Having accumulated a very large series of patients’records over a period of 60 years, some involving three generations of a family, the author has selected cases that illustrate the opportunities to observe the progress of patients from infancy for more than half a century.

This unique opportunity has included a variety of clinical conditions such as congenital syphilis, cretinism, acute osteomyelitis, and pink disease and represents a long term follow‐up of conditions which reflect both the paediatrics of the past and the changes in the pattern of disease which have occurred in the course of 60 years.
Inhaled Fenoterol powder in asthma: a long term study
Authors: DAWSON K.P. , FERGUSSON D.M. , ALLAN J.
Published: March 2008

ABSTRACT. A study was designed to assess the long term efficacy of Fenoterol powder in asthmatic children. The design included an initial assessment period and a further evaluation after six months, in which Fenoterol or placebo treatments were administered on consecutive days. Objective measurements were obtained from PEFR and FEV. A diary record was kept to monitor compliance and side effects. A minimum dose of 200 mcg Fenoterol powder was prescribed three times per day.

The bronchodilator action of Fenoterol was sustained after a period of six months, in the absence of significant side effects.
The immune status of Singapore children to hepatitis B virus
Authors: QUAK S. H. , SINGH R. , OON C. J. , WONG H. B.
Published: March 2008

ABSTRACT. In a cross‐sectional survey of hepatitis B immune status, 458 consecutive children below the age of 12 years were studied. 37.3% of these children were positive for one of the three markers, HBsAg, anti‐HBs or anti‐HBc. 15.5% were positive for two and 1.3% were positive for all three. 10.9% were positive for HBsAg, 27.8% for anti‐HBc and 19.6% for anti‐HB2. The males showed a higher HBsAg carrier rate than the females, 13.5% and 6.8% respectively. This difference was significant (p<0.05). This study confirmed that the Singaporeans were exposed to hepatitis B virus infection from very early in life and in order to prevent the infection, immunisation should be considered in early childhood.
Evaluation of bubble clicking in gastric aspirate in the newborn
Authors: TODD DAVID , JOHN ELIZABETH
Published: March 2008

ABSTRACT. Bubble clicking, foam stability tests, L/S ratio and two dimensional thin layer chromatography were done in 26 gastric aspirates obtained from 22 babies with mature lungs and 4 babies with with hyaline membrane disease.

Phosphatidyl glycerol was present in 21 of the 22 babies with mature lungs. Bubble clicking demonstrated a 95% accuracy and foam stability test 100% accuracy in predicting the presence of phosphatidyl glycerol.

Bubble clicking is a useful and easily preformed test in the clinical assessment of a preterm baby.
The needs of the abused child in the community
Authors: CARMICHAEL ALLAN
Published: March 2008

ABSTRACT. The development of community awareness of child abuse has followed medical awareness and is specifically concerned with prevention and early intervention. Contact between community services and 304 infants from a birth cohort in a poor socio‐economic status, multi‐ethnic urban municipality was documented to investigate how these services could provide effective community approaches to the problem. While perinatal and medical services provided fragmented care, the Maternal and Child Health Service was the only agency to contact all families, including those of the 21 abused or “at risk'’infants.

It is suggested that such local universal services should form the basis of a community approach to the needs of the abused or “at risk'’child.
Diabetic autonomic neuropathy in children: immediate heart‐rate response to standing
Authors: MITCHELL E. A. , WEALTHALL S. R. , ELLIOTT R. B.
Published: March 2008

ABSTRACT. The immediate heart‐rate response to standing was used to investigate possible autonomic neuropathy in a group of 38 insulin‐dependent diabetic patients in the paediatric age group. The controls and most of the diabetics showed the characteristic response to standing of a rapid increase in heart‐rate and a fall to the resting rate within 15 seconds. Some diabetics showed a flat response or a prolonged gradual increase of heart‐rate on standing. The usual method of describing the change in heart rate that occurs in response to standing is to compare the R‐R intervals at the 30th and 15th beats (30:15 ratio). This is considered less appropriate in children because of the wider variability in heart rate due to sinus arrhythmia. An alternative ratio, the “maximum R‐R/minimum R‐R ratio'’is proposed. This ratio is calculated by dividing the length of the maximum R‐R interval (which occurred after the minimum R‐R interval during the 30 second recording) by the length of the minimum R‐R interval. Compared to 38 index‐selected age and sex matched controls, the diabetics showed a significantly lower mean “maximum R‐R/minimum R‐R ratio (P = 0.033). Six of the diabetics had results lower than the lowest control result. This test gives a prevalence rate of changes suggestive of diabetic autonomic neuropathy of approximately 15% in this age group.
Successful pregnancy in β‐thalassaemia major
Authors: MARTIN KATHLEEN
Published: March 2008

ABSTRACT. Successful pregnancy is described in a patient with β‐thalassaemia major, transfusion‐dependent from four months of age and treated with desferrioxamine from 13 years of age. The pregnancy was concealed. No antenatal care was given nor any planned alteration in management of her thalassaemic state.
Socio‐economic status and childhood injuries
Authors: LANGLEY JOHN , SILVA PHIL , WILLIAMS SHEILA
Published: March 2008

ABSTRACT. The hypothesis that there was an inverse linear relationship between childhood injuries and socio‐economic status was tested. Four measures of socio‐economic status were related to childhood injury records covering the first seven years of life. The results failed to show any significant relationship between history of injury and four measures of socio‐economic status.
Bleeding ears: case report of Munchausen syndrome by proxy
Authors: BOURCHIER D.
Published: March 2008

ABSTRACT. A two and a half year old child presented with “bleeding'’ears which proved to be factitious in origin. A previous episode of haematuria, haematemesis and melaena at age 9 months was probably also factitious. A brief discussion of Munchausen syndrome by proxy is presented.
Paediatric telephone consultation — a neglected area of health service delivery
Authors: OBERKLAID FRANK , BELL JAN , DUKE VAL
Published: March 2008

Abstract Telephone enquiries to a large paediatric institution were monitored over a 4 week period. Of the 1764 calls handled during this period (an average of 63 per day), over 75% sought advice regarding symptoms of illness in their children. The commonest were to do with vomiting and diarrhoea, fever, infectious disese, respiratory symptoms and feeding problems. It is suggested that it is no longer appropriate for such calls to be handled in an ad hoc manner as is the custom in most hospitals, but that specific telephone protocols be developed and evaluated to address this important area of paediatric consultation.
Successful auditory brainstem evoked response testing and test‐age relationships in difficult‐to‐test children
Authors: SMYTH VERONICA
Published: March 2008

Abstract Thirty‐five difficult‐to‐test children under 4 years of age, suspected of hearing loss, were evaluated via auditory brainstem evoked response audiometry (ABR). Results indicated that the success of ABR without anaesthesia in such a population is enhanced by early referral.
Decreased neutrophil chemotaxis and chronic granulomatous disease
Authors: KEMP A. S. , LO E. , VERNON J. , ROBERTSON S. E. J. , PENNY R.
Published: March 2008

Abstract A case of chronic granulomatous disease associated with decreased neutrophil chemotaxis is described. It is suggested that defective neutrophil motility may be more common than previously recognized in chronic granulomatous disease. However, the presence of a chemotactic defect does not necessarily imply a more severe clinical course.
Survival after prolonged persistent pulmonary hypertension
Authors: BUTT W. W. , BOWMAN E. D. , MURTON L. J.
Published: March 2008

Abstract We report an infant with prolonged persistent pulmonary hypertension (PPH) who failed to respond to various mechanical and pharmacological therapies but who showed spontaneous improvement at 13 days of age. We therefore stress that assisted ventilation should be continued in PPH without major structural cardiac or pulmonary abnormality or ongoing iatrogenic complications, as recovery may occur at any time.
Systemic candidiasis in premature infants
Authors: HO NAI‐KIONG
Published: March 2008

Abstract Four cases of systemic candidiasis in premature infants with different clinical presentations are reported. Diagnosis of the condition can be difficult as clinical manifestations are non‐specific and Candida may not be recovered in blood culture. The condition should be suspected in predisposed babies with unabating or deteriorating infections despite appropriate antibiotic therapy. We propose routine microscopic urinary examination for Candida as a screening test for the infection.
Clinical spectrum of neonatal apnoea in very low birthweight infants
Authors: TUDEHOPE DAVID I. , ROGERS YVONNE
Published: March 2008

Abstract This study quantifies apnoea and assesses the response to xanthine derivatives amongst 172 consecutively born, surviving very low birth weight (VLBW) infants, 136 appropriate weight for gestational age (AGA), 36 small for gestatfonal age (SGA). All babies had electronic monitoring of heart and respiratory rates and nursing staff recorded episodes of apnoea (> 10 s), bradycardia (<100) and cyanosis. Only 42 (24.2%) babies had no episodes recorded. (25 AGA, 17 SGA). Sixty‐four (37.2%) received active resuscitation on at least one occasion with six babies ventilated by bag and mask on more than 10 occasions. Apnoea had commenced by day 10 of life in all the babies who had apnoea and persisted beyond day 50 in only six; however four of these infants were still requiring active resuscitation. Apnoea had ceased by 37 weeks post‐conceptual age in 88% and by 40 weeks in all but three babies.

Risk factor analysis revealed a strong correlation (P<0.005) with lower gestational ages and birth weights, respiratory distress syndrome (RDS) and the problems associated with it, such as mechanical ventilation, patency of the ductus arteriosus (PDA) and chronic neonatal lung disease. A single, reversible cause for apnoea was rarely demonstrated. Care must be exercised with feeding, physiotherapy and suctioning the pharynx and trachea of ‘at risk’ infants. Xanthine derivatives were highly effective in decreasing the frequency of recurrent apnoea from a mean of 10.08 episodes one day before, to 1.83 two days after commencement of treatment.
Home monitoring for infants at risk of the sudden infant death syndrome
Authors: TUDEHOPE DAVID I. , CLEGHORN GEOFFREY
Published: March 2008

Abstract This study evaluates the effectiveness and social implications of home monitoring of 31 infants at risk of sudden infant death syndrome (SIDS). Thirteen siblings of children dying of SIDS, nine near miss SIDS infants and nine preterm infants with apnoea persisting beyond 40 weeks post conceptual age were monitored from a mean age of 15 days to a mean of 10 months. Chest movement detection monitors were used in 27 and thoracic impedance monitors in four. Genuine apnoeic episodes were reported by 21 families, and 13 infants required resuscitation. Apnoeic episodes occurred in all nine preterm infants but in only five (38%) of the siblings of SIDS (P<0.05). Troublesome false alarms were a major problem occurring with 61% of the infants and were more common with the preterm infants than the siblings of SIDS. All but two couples stated that the monitor decreased anxiety and improved their quality of life. Most parents accepted that the social restrictions imposed by the monitor were part of the caring process but four couples were highly resentful of the changes imposed on their lifestyle.

The monitors used were far from ideal with malfunction occurring in 17, necessitating replacement in six, repair in six and cessation of monitoring in three. The parents became ingenious in modifying the monitors to their own individual requirements

Although none of these 31 ‘at risk’ infants died the study sample was far too small to conclude whether home monitoring prevented any cases of SIDS.
Role of renin and aldosterone in establishment of electrolyte balance in very low birthweight neonates
Authors: LESLIE GARTH I. , BARR PETER A. , GALLERY EILEEN D. M. , GYORY AKOS Z.
Published: March 2008

Urine sodium, potassium and chloride excretion, plasma renin activity (PRA) and urine aldosterone excretion (UAE) were measured in seven very low birthweight (VLBW) infants during the first 6 weeks after birth. Hyponatraemia was most common, and major changes in urine electrolyte excretion occurred, during the first 2 weeks. These changes in urine electrolyte excretion appeared to relate to improvement in distal tubular function. PRA did not correlate with urine excretion of either aldosterone or electrolytes. However, UAE correlated significantly with fractional sodium‐potassium exchange in the distal tubule in a non‐linear fashion (P<0.001) which suggested a threshold of aldosterone responsiveness between 70 and 100 nmol/24 h per 1.73 m2 UAE. We conclude that in VLBW infants the distal tubule can respond to aldosterone during the first 2–3 weeks, but that the threshold for responsiveness appears to be higher than it is in fullterm infants
Antimicrobial properties and microbial contaminants of breast milk — an update
Authors: MAY JOHN T.
Published: March 2008

Abstract A review of recent studies of antibacterial, antiviral and antiprotozoan factors in human breast milk is presented. Also reviewed are the microbial contaminants that have been detected in human milk with a particular focus on cytomegalovirus and rubella virus, both of which have recently been shown to infect infants via breast milk.
Morbidity during the preschool years
Authors: FERGUSSON D. M. , DIMOND M. E. , SHANNON F. T.
Published: March 2008

Abstract The prevalence of illness was studied in a birth cohort of Christchurch children during the period from birth to 5 years. By 5 years children had made an average of 18.0 family doctor consultations for morbidity and a further 4.7 for preventive health care procedures; 38% had been admitted to hospital on at least one occasion and 62% had made one or more attendances at a hospital outpatient department. The majority of general practitioner consultations involved four major groups of conditions: respiratory illness; integumental lesions; gastrointestinal illness and accidents. Hospital admissions were dominated by six groups of conditions: respiratory illness, minor surgery, accidents, feeding and management problems, admissions relating to the child's home environment and gastrointestinal illness. Two thirds of hospital outpatient attendances were accounted for by five groups of conditions: accidents; musculoskeletal conditions; respiratory illness; vision problems and congenital heart murmur.
The effect of a home exercise programme in children with cystic fibrosis and asthma
Authors: HOLZER FRANZ J. , SCHNALL ROBERT , LANDAU LOUIS I.
Published: March 2008

Abstract Sixty‐nine children with asthma and 86 with cystic fibrosis (CF) were assessed for lung function, respiratory muscle function and exercise tolerance. Thirty‐seven with aslhma and 41 with CF subsequently undertook an at home exercise program and the remainder were matched controls. There was no significant change in pulmonary function after 3 months of the exercise program. Compliance with the program decreased markedly towards the end of the 3 months and this lack of compliance may have contributed to the failure to show any significant training effect. A previously supervised program showed increased fitness and increased peak pressures in children with asthma following intensive exercise‐ There appears limited value in promoting unsupervised home exercise programs for children with CF and asthma. In those groups of children who will benefit with increased physical activity, supervised programs and more interesting play activities may need to be organized to obtain optimal benefit.
Jaundice in full term healthy neonates — a population study
Authors: CLARKSON J. E. , CCWAN J. O. , HERBISON G. P.
Published: March 2008

Abstract A geographically based population of 498 full term, appropriate for gestational age, healthy, singleton neonates was used to study the effect of obstetric and nursery practices on the occurrence of neonatal jaundice. At 3–4 days 56% of babies became visibly jaundiced (plasma bilrubin (PB)> 100 μmol/l) and 10% were hyperbilirubinaemic (PB > 200 μmol/I). Less mature babies, those slow to pass meconium and those who had lost weight at 4 and 7 days were more likely to be jaundiced. Obstetric practices, drugs given during labour, mother's or baby's blood group, natural illumination, plethora, extravasated blood or mode of feeding were found to have no effect. No benefit from giving supplementary milk or dextrose to breast fed babies was discovered.

At 6–7 days at least 9% of babies, all bout one of whom were breast fed, were visibly jaundiced. The frequency of prolonged jaundice (breast milk jaundice) was 3′.8% of breast fed babies at 3 weeks and zero by 7 weeks. The proportion of babies receiving phototherapy was 2.2%.
Selective intubation in pulmonary interstitial emphysema: experience in five patients
Authors: BOWMAN E. D. , MURTON L. J.
Published: March 2008

Abstract Selective bronchial intubation can be useful in the management of severe localized pulmonary interstitial emphysema (PIE). Five infants between 9 and 20 days old with severe left sided PIE had the right main bronchus intubated for between 4 to 30 h. Four patients showed permanent and one patient temporary improvement and the experience from these cases suggests that prolonging the procedure after obtaining radiological evidence of improvement may not be necessary. There were no serious complications although right upper lobe atelectasis occurred in three cases and could not be prevented by using an endotracheal tube with a side hole. Nevertheless, active management should only be considered in PIE causing respiratory failure or pressure effects on surrounding structures.
Cord blood G‐6‐PD activity by quantitative enzyme assay and fluorescent spot test in Chinese neonates
Authors: FOK TAI‐FAI , LAU SUM‐PING , FUNG KAM‐PUI
Published: March 2008

Glucose‐6‐phosphate dehydrogenase (G‐6‐PD) deficiency is a common X‐linked recessive disorder among the Chinese population. Neonatal screening for this condition is important and with necessary precaution, enzyme deficient infants are less likely to develop severe haemolysis and subsequent kernicterus. Screening of G‐6‐PD deficiency by fluorescent spot test on cord blood samples of 1228 Chinese neonates revealed an incidence of 4.4% in males and 0.35% in females. Simultaneous direct enzyme assay confirmed the sensitivity and specificity of the spot test in the identification of male hemizygotes and female homozygotes. However, the spot test was unsatisfactory in detecting heterozygotes. Even quantitative enzyme assay could detect only 70% of the partially deficient subjects.
Comparison of abilities of preterm and maturely born children at 5 years of age
Authors: BURNS YVONNE R. , BULLOCK MARGARET I.
Published: March 2008

This study investigated whether the development of 5 year old preterm born children was appropriate for age and equivalent to or different from their peers who were full term at birth.

At the adjusted age of 5 years, the development of 106 children born 5 or more weeks before term was compared with the development of 103 children who were born at term. This latter group of children were matched to the preterm group in sex, year of birth, birthplace, race and residential location. No cerebral palsy children were included in either subject group.

The results indicated a significant difference between the two groups. Factors distinguishing the preterm children from their full term peers included small involuntary hand movements, less competent gross motor ability, poorer verbal performance and more variability in behaviour, postural response and balance. A higher than average incidence of minor motor, speech, behaviour and learning problems in early school years is probable.
Perinatal factors, periventricular haemorrhage and mortality in very low birthweight infants
Authors: MURTON L. J. , BUTT W. W. , MACKAY R. J. , ROY R. N. D. , De CRESPIGNY L. Ch.
Published: March 2008

In a population of 225 very low birthweight infants born over a 21 month period the cerebroventricular system was scanned by ultrasound. One third of the infants developed a periventricular haemorrhage; in 41% of infants the haemorrhage was detected before an hour of age and 66% of all haemorrhages occurred within the first 24 hours.

Statistically significant associations with periventricular haemorrhage included vaginal delivery, endotracheal intubation and intravenous sodium bicarbonate when this was administered in the first 24 hours. In a stepwise regression analysis, however, these and other potentially significant variables added little to the total accountable variance. A similar analysis of perinatal factors and mortality revealed that decreasing gestation was the major association with death.
Auditory brainstem evoked response as a hearing test in infants and children: A follow up study
Authors: WESTON P. F. , MANSON J. I.
Published: March 2008

Abstract In recent years the auditory brainstem evoked response (BSER) has become an established aid in assessing hearing in unco‐operative subjects. We have reviewed our experience with this technique in 293 infants and children aged less than 11 years. We have found that the threshold for click BSER correlates well with the average audiometric threshold in the 2–4 kHz range. We have had encouraging preliminary experience to support the claim by other workers that 500 Hz stimuli may be used to assess low tone auditory function. In interpreting results it is important to appreciate that hearing levels may fluctuate with disorders such as otitis media and occasionally in cases of meningitis. Caution is also advised in interpreting results in cases where central nervous system pathology capable of affecting auditory pathways is known to exist.
Cystic fibrosis heterozygotes have normal autonomic innervation of the heart
Authors: MITCHELL E. A. , PATEL H. , WEALTHALL S.R.
Published: March 2008

Abstract Five simple tests of autonomic nerve function based on measurements of cardiovascular responses to various stimuli were used to investigate possible autonomic dysfunction in obligate heterozygotes for cystic fibrosis. There were no significant differences between the heterozygotes and control groups in any of the tests, suggesting that cystic fibrosis heterozygotes have normal autonomic innervation of the heart.
Immunosuppressive therapy for diabetes mellitus
Authors: WERTHER GEORGE A.
Published: March 2008

Type I (Juvenile) diabetes mellitus affects 1‐2 per thousand children, committing them to a lifetime of once or twice‐daily insulin injections, dietary restrictions, and self‐monitoring of blood glucose, as well as placing extra physical, emotional and social demands on the family. In spite of careful adherence to these guidelines and recent improvements in diabetic care, we are unable to anticipate a normal lifespan and freedom from diabetic renal, eye, and neural complications for these children. The most recent figures suggest that lifespan is reduced by as much as 25 years in 50% of patients, primarily due to renal failure. Mortality in diabetes is increased tenfold at any age.1 Severe visual impairment secondary to diabetic retinopathy is likely within 25 years of diagnosis in 50% of patients.2
Cranial ultrasonography as a diagnostic and predictive tool in neonatal periventricular haemorrhage
Authors: TUDEHOPE D. I.
Published: March 2008

Over the last 5 years realtime ultrasonography has become the most important diagnostic tool in evaluating intracranial haemorrhage and ventricular dilatation as well as structural anomalies of the newborn brain. There is excellent correlation between ultrasound findings and those of both computed tomography and autopsy.1 Unlike computerized tomography ultrasound does not use ionizing irradiation, is relatively inexpensive, can be carried out quickly and repeatedly at the cotside and involves little disturbance of the infant. With these attributes it is not surprising that it is being used both for diagnosis in infants with symptoms suggestive of periventricular haemorrhage (PVH) or hydrocephalus, and as a scanning tool for infants of birthweight less than 1500‐2000 g and/or gestational age less than 33‐35 weeks.
The diagnosis of periventricular leukomalacia
Authors: LEVENE M. I.
Published: March 2008

During the last trimester of pregnancy the perinatal brain undergoes rapid growth and development and premature delivery exposes the brain to complications of circulatory instability including haemorrhage and ischaemia. The type of cerebral injury sustained depends on gestational age, the nature of the insult and the timing of the event. Although compromise of the cerebral circulation is more likely to occur in the infant born premature, the fetus is also dependent on adequate cerebral perfusion and should this fail the unborn infant is liable to similar neuropathological damage as his prematurely born peer.
Outcome of intrauterine periventricular haemorrhage and leukomalacia
Authors: SZYMONOWICZ W. , YU V. Y. H.
Published: March 2008

This case study reports five very low birthweight infants with ultrasound evidence of intrauterine insult to the brain. Intrauterine periventricular haemorrhage (PVH) accompanied by ventricular dilatation occurred in two preterm infants both of whom survived and were severely handicapped at follow‐up. Three preterm infants had intrauterine periventricular leukomalacia (PVL); one survived and is severely handicapped at one year of age. Our experience and rare case reports in the literature indicate that intrauterine PVH and PVL carry a high risk of death in the neonatal period and severe neurological sequelae in survivors.
Cutis laxa with delayed development
Authors: ROGERS JOHN G. , DANKS DAVID M.
Published: March 2008

Two forms of cutis laxa are well delineated. One is a dominant benign disorder in which the greatest impact is on the skin, and the second is an autosomal recessive variety with serious lung involvement and early death. A third form of cutis laxa of intermediate severity, associated with mental and growth retardation, has been described. We report seven patients with this intermediate form. All patients showed marked skin changes early in life and had some degree of mental retardation which ultimately proved less severe than it appeared at presentation.

Previous reports have suggested that this disorder occurs in females and may be an X‐linked dominant condition which is lethal in males. The finding of four affected males in this series makes this explanation unlikely. As consanguinity and affected sibs have been reported previously it is probably an autosomal recessive disorder.
Health screening at school entry—what is achieved?
Authors: REZNIK ROBERT , STARTE DAVID , MOREY SUE
Published: March 2008

Abstract Evaluative research on screening in school children is needed because of a lack of studies about its effectiveness. This paper reports a study of the school medical records of 790 children, aged 5‐6 years, first screened in 1980. Sixty‐six per cent of the parents of children who were notified of an abnormality in their child were followed up to determine subsequent action. Although a complete physical examination had been performed, 87% of all notified abnormalities involved vision (including squint), hearing and dental problems. The prevalence rate of previously unknown health problems (excluding dental problems) confirmed by another health professional was 5%. This rate was lowered to 2% when only children with moderate or severe problems presently receiving treatment were included. Some of the practical problems and importance of screening are discussed.
Complement C8 deficiency with recurrent meningococcemia: Examination of meningococcal opsonization
Authors: KEMP A. S. , VERNON JENNIFER , MULLER‐EBERHARD H. J. , BAU D. C. K.
Published: March 2008

Abstract A 10 year old girl presented with recurrent febrile episodes over 2 months. A non‐typable strain of Neisseria meningitidis was grown from blood cultures on three occasions. She was found to lack functional C8 activity in serum but material with C8 antigenic activity was present. The opsonic activity of the C8 deficient serum for N. meningidis was equivalent to that of normal controls.
Post‐haemorrhagic hydrocephalus in the preterm infant
Authors: SZYMONOWICZ W. , YU V. Y. H. , LEWIS E. A.
Published: March 2008

Abstract This prospective study documents the incidence, clinical features and risk factors for post‐haemorrhagic hydrocephalus (PHH) as well as the short‐term outcome after serial CSF taps. Serial real‐time ultrasound scans were performed on 220 infants: on all admissions ≤1250 g and on an additional 130 infants with birthweights >1250 g with risk factors for intraventricular haemorrhage (IVH). Based on percentile charts of postnatal increase in ventricular size and head circumference growth rate, PHH was defined as ventricular dilatation >95th centile associated with either a head circumference growth >95th centile or with clinical features of raised intracranial pressure (ICP). Forty‐eight (22%) infants were found to have IVH of whom 14 had intracerebral extension of IVH. Sixteen (40%) of 40 infants who survived the acute episode of IVH developed PHH. PHH occurred more commonly in those who survived severe birth asphyxia and/or intracerebral extension of IVH. Fifteen infants who developed clinical features of raised ICP were treated with serial CSF taps. This procedure was effective in a staged treatment for PHH in relieving clinical symptoms and deferring ventriculo‐peritoneal (VP) shunting. Morbidity associated with serial CSF taps and VP shunting is minimal. A high red cell count and protein concentration in the CSF at diagnosis of PHH identified all five infants who subsequently required VP shunting.
Depression in childhood
Authors: BIRLESON P.
Published: March 2008

If a man eat garlick (sic), onions, fast overmuch, study too hard, be over sorrowful, dull, heavy, dejected in mind, perplexed in his thoughts,… (his) children will be much subject to madness and sorrow. Robert Burton, The Anatomy of Melancholy (1621)
At comparative study of the bronchodilating effect of oral fenoterol and salbutamol in children with asthma
Authors: VAN ASPEREN PETER P. , MANGLICK PATRICIA
Published: March 2008

Twelve children with asthma and persistent airflow obstruction were studied to determine the degree and duration of bronchodilation achieved following oral fenoterol compared to oral salbutamol. Each child received oral fenoterol, oral salbutamol or placebo in a randomized double‐blind manner and pulmonary function was recorded up to 6 h after the dose. The baseline FEV1, did not differ between the three groups. The responses to oral fenoterol and salbutamol, measured as the percentage change from the baseline FEV1, were significantly greater from 1 to 6 h after treatment compared with responses to placebo but there were no significant differences in the responses to the two active medications. It is concluded that, using the manufacturers' recommended doses, there is no difference between oral fenoterol and oral salbutamol in term of their bronchodilator effectiveness and duration of action.
Use of Mercurochrome in the management of the large exomphalos
Authors: BEASLEY SPENCER W. , JONES PETER G.
Published: March 2008

The topical application of solutions containing mercury has remained popular in the conservative management of the large exomphalos, despite recent reports of high organ mercury levels occurring in neonates who have died following this type of treatment. There are few reports of mercury poisoning being recognized in survivors. This report records blood and urine mercury levels in four patients with no apparent sequelae after treatment with Mercurochrome and provides guidelines for the safer use of mercurial solutions in the conservative management of exomphalos: one thin application of 1% Mercurochrome be applied to the intact sac; thereafter, Mercurochrome be applied sparingly only to areas that remain moist; blood and urine levels of mercury be monitored routinely; and applications ceased whenever mercury levels exceed the minimum toxic level. Only with this paring and judicious use of mercurial solutions is the hazard to the infant kept to a minimum.
Biotin‐reversible neurodegenerative disease in infancy
Authors: LOW L. C. K. , STEPHENSON J. B. P. , BARTLETT K. , SEAKINS J. W. T. , SHAIKH S. A.
Published: March 2008

Two siblings with consanguineous parents began having myoclonic jerks at age 5 months after introduction of mixed feeding. There was later developmental regression. The elder girl died without diagnosis aged 1 year, after prolonged continuous hyperventilation. The younger sibling did not have metabolic acidosis when first investigated for myoclonus and hypotonia aged 5 months. At 9.5 months, when intermittently decerebrate and hyperventilating, she had a metabolic acidosis with elevated blood lactic, pyruvic and β‐hydroxybutyric acids, and β‐hydroxyisovaleric aciduria. On the assumption that she had β‐methylcrotonyl‐CoA carboxylase deficiency she was started on biotin, 10 mg daily. Within 36 h there was dramatic clinical and biochemical improvement. Previously defective eye movement control and gaze became normal, hyperventilation ceased, and excessive organic acid excretion in urine was abolished. She remains on long‐term biotin and at age 2 years her development appears normal in all respects. Fibroblast culture however revealed normal quantities of the enzymes β‐methyl‐crotonyl‐CoA carboxylase, propionyl‐CoA carboxylase and pyruvate carboxylase. Irrespective of the niceties of enzyme and organic acid biochemistry, the clinician must be aware of biotin‐reversible regressive brain disease which may present before manifest metabolic acidosis.
The development of children with Down's syndrome: Lessons from the past and implications for the future
Authors: CLUNIES‐ROSS G. G.
Published: March 2008

In the opening chapter of their scholarly edition on Down's syndrome, Rynders and Pueschel indicated that the present precetion of the condition is still sometimes medieval.1 Notwithstanding the dramatic growth in present knowledge about Down's syndrome over the last 2.5 decades, “the dark ages never disappear completely from any developmental disability because ignorance, prejudice, and good intentions that go astray seem to be with us always…”1 Rynders and Pueschel reported that as recently as 1970 the Encyclopaedia Britannica described Down's syndrome under the heading of ‘monster’. They also cited a 1968 article in which a theologian and moral philospher wrote, “People… have no reason to feel guilty about putting a Down's syndrome baby away, whether it's ‘put away’ in the sense of hidden in a sanitarium or in a more responsible lethal sense … True guilt arises only from an offense against a person, and a Down's is not a person.” A 1975 article in a ‘popular’ psychology magazine quoted the head of the Reproductive Genetics Unit at a USA university hospital as saying, “You show me just one mongoloid that has an educable IQ … I've never seen even one in my experience with over 800 mongols.”2
A survey of paediatric management practices in Down's syndrome
Authors: FOREMAN P. J. , WARD J.
Published: March 2008

Paediatricians throughout Australia and New Zealand completed a questionnaire in which they indicated the type of advice the normally give to parents of children with Down's syndrome. Results indicated strong support for early intervention, discussion with other parents of children with Down's syndrome, and conventional therapy services. Cosmetic surgery appears to be receiving increasing support. Megavitamin therapy, cell therapy and the Doman programme are unsupported. A tendency was noted for paediatricians to underestimate the developmental potential of children with Down's syndrome.
The development of Australian normative data for infant temperament
Authors: OBERKLAID F. , SANSON A. V. , PRIOR M.
Published: March 2008

Utilizing the revised Infant Temperament Questionnaire previously validated for use with Australian populations, a cohort of 2443 infants aged 4‐8 months was studied. This sample was recruited in such a manner as to be representatives of all infants of this age group in the State of Victoria. Temperament values obtained differed significantly from American norms on four of the nine temperament dimensions, providing further evidence for the importance of using culturally appropriate norms. There were associations between temperament and problem behaviours and some parent characteristics. The normative values for temperament presented are recommended for use in Australian settings.
Pulmonary interstitial emphysema in infants less than 1000 g at birth
Authors: YU V. Y. H. , WONG P. Y. , BAJUK B. , SZYMONOWICZ W.
Published: March 2008

Eighty (32%) of 249 infants weighing less than 1000 g at birth developed pulmonary interstitial emphysema (PIE); its incidence was 42% in infants at 500‐799 g, 29% at 800‐899 g and 20% at 900‐999 g. Fifty‐five per cent occurred in the first 24 h and 43% were associated with other forms of air leak. The incidence and mortality of PIE did not improve between 1977 and 1984. The mortality rates in infants with or without PIE were not significantly different in the first 4 years of the study period (53% vs 45%). As the mortality improved in infants without PIE during the second 4 years, the difference in mortality rates in infants with or without PIE became significant (68% vs 29%). PIE continues to be associated with serious mortality and morbidity in extremely low birthweight infants. Effective measures to prevent PIE are required before further improvement in their outcome can be achieved.
Sarcoidosis in children
Authors: ROBINSON P. J. , OLINSKY A.
Published: March 2008

Abstract Eight patients with sarcoidosis seen at the Royal Children's Hospital, Melbourne, during the past 10 years were reviewed. Five of the eight patients came form non‐metropolitan areas. The major presenting symptoms were cough, fatigue and weight loss; peripheral lymphadenopathy and hepatomegaly were common. None of the patients had eye or central nervous system involvement. Seven patients had bilateral hilar adenopathy on chest radiography and six had parenchymal lung changes. Angiotensin converting enzyme was measured in six patients and was elevated in all, while hypercalcaemia was present in three patients. Five patients had a tissue biopsy showing the characteristic non‐caseating granulomas. Corticosteroid therapy was used for four patients and was given for hypercalcaemia in three patients and for severe restrictive lung disease in one patient.
Community Outreach: An expanding role for hospitals
Authors: SEWELL J. , OBERKLAID F. , DEBELLE G. , CULLEN J. , CARMICHAEL A. , FINNOCCHIARO C.
Published: March 2008

Abstract Pressures for paediatric institutions to expand their traditional roles have come from changes in morbidity patterns, training requirements and community needs. Planning for new models of health care delivery has led to the development of the Community Outreach Program (COP), a hospital‐based model which utilizes existing community resources to provide early intervention services, training in community paediatrics and integtration of hospital and community based health care.

A process evaluation of the COP was performed after 18 months operation. Eighty‐eight children were seen in a 7 week period, 20% with complex problems requiring further assessment and community consultation. Staff at the community agencies serviced considered the COP to be a major contributor to health care in their areas. Medical trainees developed new assessment techniques and management strategies for children with problems not previously encountered. It appears that the COP is a useful model for the delivery of health care, in particular to disadvantaged communities.
The emergence of Serratia marcescens as a pathogen in a newborn unit
Authors: WAKE C. , LEES H. , CULL A. B.
Published: March 2008

Abstract During a 12 month period, the Waikato Hospital Newborn Intensive Care Unit experienced an epidemic of Serratia marcescens infection. Seventeen serious infections occurred, resulting in three deaths. A further 15 cases of minor infection were also noted. Although no point source of introduction was found, gut colonization proved to be the most important reservoir for nosocomial spread of the organism. At the peak of the outbreak, a 95% incidence of rectal colonization with S. marcescens was observed. Eradication was achieved within a 4 month period using cohort isolation of affected infants.
An evaluation of cell therapy in Down syndrome
Authors: FOREMAN P. J. , WARD J.
Published: March 2008

A group of children with Down syndrome who were being treated with cell therapy was matched for age and sex with an untreated control group. Comparisons were made between the groups with respect to a number of developmental and physical variables which have been reported to be influenced by cell therapy. Of 55 comparisons made between treated and control groups, two differences were statistically significant. This study failed to show sufficient significant results for the treatment to be regarded as effective.
Comparison of a positive expiratory pressure (PEP) mask with postural drainage in patients with cystic fibrosis
Authors: ASPEREN P. P. VAN , JACKSON L. , HENNESSY P. , BROWN J.
Published: March 2008

The use of a positive expiratory pressure (PEP) mask was compared with postural drainage in the treatment of 10 patients with cystic fibrosis. The patients were allocated randomly in a crossover fashion to the two regimens and evaluated initially by a physiotherapist and over a 4 week treatment period by use of a diary card. There was no significant difference in sputum production or change in lung function between each technique as assessed by the physiotherapist. Diary card evaluation also failed to demonstrate a difference in sputum production, symptom score or peak expiratory flow rate between the 4 week treatment periods. It was concluded that PEP mask therapy is an acceptable and effective alternative to postural drainage in interval therapy of patients with cystic fibrosis, although the patients have tended to revert to postural drainage during acute exacerbations.
Spontaneous resolution of extrahepatic biliary obstruction in a neonate
Authors: EVANS J. E. , VANCE J. C.
Published: March 2008

A patient with spontaneous resolution of complete extrahepatic biliary obstruction shortly after the neonatal period is described. Liver biopsy prior to resolution revealed widened portal tracts and extensive fibrosis; these changes normalized following resolution. The aetiology was not established but possibilities included a choledochal cyst, localized inflammation; for example, pancreatitis, a calculus of the common bile duct or a congenital membrane. Management of this patient would have been advanced if there were a paediatric size side‐viewing duodenoscope which would have diagnostic and therapeutic potentials.