bluuebunny/crossref_metadata_2025 huggingface dataset:
Iron deficiency in Bourke children
Authors: HARRIS M. F. , CAMERON B. , FLORIN S.
Published: March 2008

Abstract A study of 121 Aboriginal and 91 non‐Aboriginal children aged 6 years and under was carried out in Bourke during 6 months of 1986. These children were selected either because they were admitted to hospital and had an incidental blood test or were screened at various childcare and preschool facilities in the town. A haemoglobin level of below 100 g/l was found in 12.4% of Aboriginal children compared with only 3.3% of non‐Aboriginal children. A mean corpuscular volume of less than 80 was found in 15.7% of Aboriginal children and 3.3% of non‐Aboriginal children. Of the total sample, 17.4% of Aboriginal children and 6.6% of non‐Aboriginal children had a serum ferritin level of less than 10 ng/ml. These markers of iron deficiency were associated with low weight and crowded living conditions in Aboriginal children. The prevalence of haemoglobin below 100 g/l among Aboriginal children under 5 years has fallen from 24.7% in 1971 to 14.1% in 1986.
Infant feeding in Sydney: A survey of mothers who bottle feed
Authors: LILBURNE A. M. , OATES R. K. , THOMPSON S. , TONG L.
Published: March 2008

Abstract Two hundred and seventy‐four mothers who were bottle feeding their infants aged from 1 to 9 months, were interviewed. Particular attention was paid to mixing technique, storage of reconstituted formulae, the reasons for deciding to bottle feed and what influenced the choosing of a particular milk. Following the interview, a sample of milk from a previously prepared bottle was taken to measure osmolality and bacterial colony count. Eighty‐two per cent of the mothers had initially attempted breast feeding. The commonest reason for changing to a bottle was that the mother felt she was not able to produce enough milk to satisfy the baby. Thirty per cent chose the milk they were using on the recommendation of the maternity hospital. Errors in reconstituting the formulae, compared with the manufacturer's instructions were made by 100 (30%) mothers. In 52 cases these were potentially serious errors, usually erring on the side of preparing an over‐concentrated formula. This finding from the interviews was confirmed by osmolality analysis of milk samples. Twenty‐two per cent of samples collected grew potential pathogens. There was no correlation between the presence of bacterial growth and the use of prewarmed formulae stored in insulated carriers. No correlation was found between triceps skinfold thickness, age of introduction of solids or method of reconstitution of formula.
Vasoactive intestinal peptide secreting tumours in children: A case report with literature review
Authors: QUAK S. H. , PRABHAKARAN K. , KWOK R. , O'REILLY A. P.
Published: March 2008

Abstract A 3 year old Chinese girl with watery diarrhoea, abdominal distension and hypokalaemia due to a thoracic paraspinal vasoactive intestinal peptide (VIP) secreting ganglioneuroma is reported. The pre‐operative serum VIP was 314 pmol/l (normal <30). Her diarrhoea stopped after the removal of the tumour. The VIP was 14 pmol/l 6 months post‐operatively. Review of the 19 reported cases in children with documented elevated serum VIP showed that many of the cases presented with watery diarrhoea for prolonged duration before the diagnosis was made. Earliest age of onset was 2 weeks of age. The male to female ratio was 9:10. Ganglioneuroma and ganglioneuroblastoma were the commonest tumours. Pancreatic non‐β cell hyperplasia and neurofibroma were also reported. Location of the tumour was variable: neck, chest or abdomen. Increased urinary catecholamine excretion was reported in 50% of the cases. Abdominal distension, flushing, episodic hypertension and failure to thrive were the other associated features.
Clinical spectrum and outcome of neonatal convulsions
Authors: TUDEHOPE D. I. , HARRIS A. , HAWES D. , HAYES M.
Published: March 2008

Abstract The clinical spectrum and outcome of neonatal convulsions within an obstetric hospital population were reviewed for the 5 years, 1978–82, inclusive. There were 156 convulsing neonates managed at the Mater Mothers Hospital (110 inborn, 46 outborn). The incidence of early neonatal convulsions for inborn babies was 3.0/1000 live births. Antenatal and perinatal risk factors were compared between the 156 convulsing infants and the 36 082 infants born during the same period who did not convulse. The leading risk factors for convulsions were prematurity, intra‐uterine growth retardation, low 5 min Apgar score, pre‐eclampsia, antepartum haemorrhage, twin pregnancy and breech presentation. The predominant seizure type was tonic in 28.6%, multifocal clonic in 27.2%, subtle in 18.4%, myoclonic in 15.0% and focal clonic in 8.8%. Mortality (31%) and long‐term disability (43%) rates were high. Tonic seizures had the highest mortality and morbidity. Throughout the duration of the study period infants received increasingly thorough investigation. Causative factors were determined in 95% of convulsing infants, most frequent being hypoxic‐ischaemic encephalopathy (40.3%) and cerebroventricular haemorrhage (30.5%).

Follow‐up data on 99 of the 107 survivors (93%) revealed severe disability in 25, moderate disability in eight and mild disability in 10. A poor long‐term prognosis was associated with prolonged convulsions, tonic and multifocal clonic convulsions, convulsions due to asphyxia and cerebroventricular haemorrhage and an abnormal neurological examination at discharge.
Congenital adrenal hyperplasia in females with viriiized genitalia: The problem of delayed diagnosis
Authors: LUTHRA M. , HUTSON J. M. , WARNE G. L.
Published: March 2008

Abstract Six girls with the non‐salt‐losing form of congenital adrenal hyperplasia are described. Diagnosis was delayed in five, the range of ages of diagnosis being 19 months‐7 years. In the sixth, despite early diagnosis and medical treatment, surgery was delayed electively until she was 3 years old. The five in whom diagnosis was delayed were all viriiized with a markedly advanced bone age and reduced adult height prognosis. Diagnosis was delayed for a variety of reasons: misinterpretation of laboratory data (one), lack of availability of medical assistance (one), language problems (one), maternal inexperience (one), and failure of the doctor to recognize an obvious clinical abnormality (one).

All six children came from immigrant families, and all except one was born in a major centre. None was born before 1979.
Cramps following exercise
Authors: BYE A. M. E. , KAN A. E.
Published: March 2008

Abstract A 13‐year old boy presented with a 10‐year history of severe muscle cramps experienced an hour after prolonged exercise. There was no history of exercise intolerance or myoglobinuria. A muscle biopsy showed a lipid myopathy and a deficiency of muscle carnitine palmityl transferase. He has responded to a high carbohydrate, low fat diet with added carbohydrate intake preceding extensive exercise. Diagnosis of this entity before an episode of rhabdomyolysis is unusual.
Neonatal ascites due to congenital jejunal obstruction
Authors: VOSS L. M. , HADDEN W. , PEASE P. W. , CLARKSON P. M.
Published: March 2008

Abstract Small bowel atresia may present with congenital ascites. A neonate with ascites was found to have jejunal atresia complicated by volvulus and perforation.
The changing pattern of severe neonatal staphylococcal infection: A 10‐year study
Authors: TAM A. Y‐C. , YEUNG C‐Y.
Published: March 2008

Abstract Forty‐two cases of severe staphylococcal infection occurring over a 10‐year period in the neonatal unit at Queen Mary Hospital are described. There was a 4.5‐fold increase in incidence in the latter half of the study period, when methicillin‐resistant Staphylococcus aureus (MRSA) emerged. The isolated MRSA were also resistant to gentamicin, but sensitive to vancomycin, fusidic acid, co‐trimoxazole and amikacin. Comparison between MRSA and methicillin‐sensitive cases showed that the former was associated with a longer hospital stay after diagnosis. Overall mortality was 9.5%. Two cases with meningitis died. MRSA is at least as virulent as its methicillin‐sensitive counterparts. The treatment implications of severe neonatal staphylococcal infection are discussed.
Vitamin A status of children with a history of respiratory syncytial virus infection in infancy
Authors: PINNOCK C. B. , DOUGLAS R. M. , MARTIN A. J. , BADCOCK N. R.
Published: March 2008

Abstract In order to extend our earlier observation that children who experience frequent respiratory episodes may benefit from Vitamin A supplementation, 206 children aged 2‐7 years who had been hospitalized for bronchiolitis during infancy were randomized into a controlled trial of Vitamin A supplementation. Of these, 149 met the criteria of protocol compliance after 12 months of follow‐up. Mean plasma retinol at baseline was 39.2 μg/100 ml (s.e.m. = 1.0) and did not increase after 12 months (mean = 36.0 μg/100 ml, s.e.m. =0.7) despite the older age of the cohort. The range observed (11.7–73.9 μg/100 ml) included some children at risk of marginal Vitamin A deficiency. Mean plasma retinol levels were 20% lower than those of children experiencing frequent respiratory episodes recorded earlier. Oral supplementation did not change plasma retinol levels, nor did it affect respiratory morbidity.
The Free Limb Scheme and the limb‐deficient child in Australia
Authors: JONES L. E.
Published: March 2008

Abstract A review was undertaken of computerized data on 547 children aged 0‐14 years, treated under the Free Limb Scheme in Australia in the years 1981‐85, and of children in New South Wales, Queensland and South Australia having major amputations in some of these years. The male/female ratio was 1.8:1. There were 171 children with upper limb deficits and 376 children with lower limb deficits. The distribution of the limb deficits of the children treated under the free limb scheme is shown. The ratio of congenital:acquired limb deficiency is known for New South Wales and was 3.7:1. The prevalence of prosthetic use in Australian children is 14.8/100 000 children.
Postnatal age at time of death in infants born at 24‐32 weeks’gestation
Authors: LESLIE G. I. , ARNOLD J. D.
Published: March 2008

Abstract Medical records of all 483 infants live‐born at 24‐32 weeks’gestation in our hospital during the years 1982‐86 were reviewed in order to determine postnatal age at time of death for those who died in the first year after birth. Twenty‐seven died from immaturity without receiving intensive care and 11 died from lethal congenital malformations. Eighty (18%) of the remaining 445 who received intensive care died: 31% on day 1, 45% on days 2‐7, 12% on days 8‐28 and 11% on days 29‐365. The neonatal mortality rate for those receiving intensive care was 160/1000, and the postneonatal mortality rate was 20/1000.

Delayed mortality was most common in infants of 26‐27 weeks’gestation, with 20% (five) of their deaths occurring after 28 days. In each gestational age range, the majority of hospital admission days were occupied by survivors (24‐25 weeks = 62%; 26‐27 weeks = 91%; 28‐29 weeks = 91%; 30‐32 weeks = 99%) rather than non‐survivors.

Whilst postneonatal mortality is a significant concern, these data suggest that if infants born at less than 33 weeks’gestation are offered intensive care and survive the early neonatal period, the long‐term outcome is more likely to be survival rather than delayed death. Furthermore, the majority of hospital admission days invested in such infants involves those who will be discharged home rather than those who will not.
Transfusion‐associated fall in platelet count in very low birthweight infants
Authors: AUSTIN N. , DARLOW B. A.
Published: March 2008

Abstract Thirty‐three infants with a birthweight of less than 1500 g were investigated retrospectively for the incidence and aetiology of thrombocytopenia occurring during the first week of life. The platelet count fell below 100 × 109/l in 16 infants (48%). There was a moderately strong inverse correlation between the platelet count at its nadir during the first week or the first value below 100 × 109/l and the percentage of blood volume transfused prior to this (r=−0.61; P< 0.0001). When the platelet count was expressed as a percentage of the initial count the correlation was −0.74 (P< 0.0001). The results were not affected by the elimination of the 10 infants with clinical conditions regarded as a probable cause of thrombocytopenia. The fitted least‐squares regression line suggests that a transfusion equal to 10% of the blood volume on average reduced the platelet count by 19 × 109/l or by 7% in these very low birthweight infants during the first week of life.
Insulin infusions in infants of birthweight less than 1250 g and with glucose intolerance
Authors: HERON P. , BOURCHIER D.
Published: March 2008

Abstract Fifteen preterm babies (mean gestation: 26.7 weeks; mean birthweight 860 g) with significant glucose intolerance were treated with insulin infusions. During the insulin infusions there was a significant increase in both the mean energy intake (60.8 ± 25.1 cal/kg per day to 79.9 ± 24.5 cal/kg per day; P< 0.001) and the mean amount of intravenous dextrose tolerated (7.0 ± 2.7 mg/kg per min to 9.2 ± 2.6 mg/kg per min; P< 0.01). The infusions were initiated at a mean postnatal age of 5.3 days (range: 2–12 days) and were continued for 1.5–17.5 days. Of the 998 blood glucose estimations performed during the insulin infusions, 28 (2.8%) were <2 mmol/l and 216 (21.6%) > 8 mmol/l. We conclude that continuous insulin infusion is a safe and effective way of managing glucose intolerance in very low birthweight infants, provided adequate means for continuous monitoring of blood glucose are available.
Late onset bowel stenoses after neonatal necrotizing enterocolitis
Authors: SEN S. , RAJADURAI V. S. , FORD W. D. A.
Published: March 2008

Abstract In 14 cases of bowel stenoses occurring after neonatal necrotizing enterocolitis (NEC), eight cases presented early, within 8 weeks from the onset of NEC and three beyond 4 months. In the other three cases the stenoses occurred in defunctionalized loops. The late onset stenoses remained undiagnosed until they presented with acute, life‐threatening complications, and one of these patients died. We draw attention to these late onset stenoses which could be missed in early contrast studies, and recommend a study at 4 months rather than at 4 weeks, as previously recommended. Those presenting early should not be missed, as all of our cases presented with acute and obvious intestinal obstructions, and they were all still in hospital or undergoing frequent review.
Transient primary hypothyroidism in the newborn: Experience of the Victorian Neonatal Thyroid Screening Programme
Authors: COAKLEY J. C. , FRANCIS I. , GOLD H. , MATHUR K. , CONNELLY J. F.
Published: March 2008

Abstract Between May 1977 and December 1986, the Victorian Thyroid Screening Programme tested approximately 570 000 newborns for congenital hypothyroidism. One hundred and sixty‐six cases of primary hypothyroidism, confirmed by formal thyroid function tests, were identified, of which 24 were later found to be transient. In addition, there were two patients with permanent dyshormonogenesis who passed through a stage of being biochemically euthyroid and so could have been diagnosed mistakenly as transient hypothyroidism. Fourteen of the transient cases were due to excessive intake of iodine. In two, this was due to maternal ingestion of iodide during pregnancy and in 12 the babies received large amounts of topical iodine antiseptic. Two cases were caused by maternal anti‐thyroid antibodies and in eight instances the cause was unknown. The large number of cases due to the topical application of iodine antiseptic emphasizes the need for caution when using this substance in neonates.
Morbidity from 5 to 10 years
Authors: HORWOOD L. J. , FERGUSSON D. M. , SHANNON F. T.
Published: March 2008

Abstract The prevalence and incidence of illness was examined in a birth cohort of Christchurch children studied during the age range of 5–10 years. At this age, children had an average of 12 consultations with family doctors; 26% were admitted to hospital and 53% made one or more attendances at hospital outpatient departments. The majority of general practitioner contacts involved five groups of conditions: respiratory illness; integumental lesion; accidents; gastrointestinal conditions; and hearing problems. Hospital admissions were dominated by five types of admission: respiratory illness; accidents; gastrointestinal conditions; genito‐urinary problems; musculoskeletal problems. More than two‐thirds of outpatient attendances were accounted for by accidents, respiratory illness, musculoskeletal problems, vision problems, and hearing problems. Trends in rates of medical consultation for accidents and respiratory illness during the period from birth to 10 years are described and the implications of the findings are discussed.
Evaluation of direct and buffy coat films of peripheral blood for the early detection of bacteraemia
Authors: RODWELL R. L. , LESLIE A. L. , TUDEHOPE D. I.
Published: March 2008

Abstract During an 8 month period, 298 evaluations of direct and buffy coat films of peripheral blood for the detection of bacteraemia were undertaken in 287 infants (243 less than 24 h of age and 55 aged between 2 days and 30 days). Bacteraemia was diagnosed by simultaneously drawn aerobic and anaerobic blood cultures. Intracellular organisms were observed in both the direct and buffy coat films of only four of 24 infants with bacteraemia, giving a sensitivity of 17%, specificity of 100% and positive and negative predictive values of 100% and 93%, respectively. Of 12 infants with bacteraemia on the first day of life, eight were asymptomatic when studied, and none of the 12 had positive smears. As two of four infants with positive smears died, it is concluded that in fulminating sepsis the tests seem to correlate with the degree of illness and may give useful information as to the causative organism and the choice of antibiotic. However, as a screening test, the present methodology lacks sensitivity and cost‐effectiveness.
Inappropriate use of contrast studies prior to referral of neonatal gastrointestinal anomalies and bowel obstruction
Authors: GILLAM G. L. , McDOUGALL P. N. , BOLDT D. W.
Published: March 2008

Abstract Ten cases of neonatal gastrointestinal anomalies and bowel obstruction are described, in which contrast studies were carried out prior to transfer. Nine of the 10 infants had bile‐stained vomiting, indicating the need for immediate surgical referral. The contrast studies resulted in delayed referral, deferment of appropriate resuscitation, and complications associated with the study. In several cases the wrong type of study, or the wrong contrast medium was used. These 10 infants required urgent surgical referral, not a sophisticated radiological procedure in geographic and surgical isolation.
Intestinal perforation in children
Authors: WARDHAN H. , GANGOPADHAYAY A. N. , SINGHAL G. D.
Published: March 2008

Abstract There were 102 cases of intestinal perforation seen in children at the Department of Paediatric Surgery at S.S. Hospital, Varanasi during a 3 year period. Enteric (typhoid) perforation (29%), intussusception (15%) Ascaris Iumbricoides infestation (9%) and appendicitis (9%), which are rarities in the reported literature, were the major causes of intestinal perforation. Radiological evidence of pneumoperitoneum was seen in 88% of patients. The majority of cases in this study were older than 5 years of age (48%). Peritoneal fluid culture revealed Escherichia coli and Klebsiella to be the most common aerobic micro‐organisms, while Bacteroides fragilis, Clostridia and Peptostreptococcus were the most frequent anaerobes. The overall mortality rate was high (19%).
Epilepsy surgery in Sturge‐Weber syndrome
Authors: BYE A. M. , MATHESON J. M. , MACKENZIE R. A.
Published: March 2008

Abstract A patient with Sturge‐Weber syndrome developed seizures at the age of 4 years. At 13 years of age, she had intractable complex partial seizures with marked visual symptomatology. Interictal encephalograms showed bilateral slow activity, more marked over the right hemisphere with epileptogenic activity maximal in the right temporal region. Serial computerized axial tomography scans demonstrated evoluton of bilateral occipital lesions with calcification and adjacent low density areas that were more marked on the right. Magnetic resonance imaging, angiography and neuropsychological evaluations were performed. An extensive resection of the right occipital lobe was achieved. One year after surgery, the patient has had seven brief seizures. Delineation of an epileptogenic focus and surgical removal of the lesion in patients with intractable seizures can now be considered in selected patients with bilateral central nervous system pathology.
Arrhythmogenic right ventricular dysplasia in a child with congenital enteropeptidase deficiency and hypogammaglobulinaemia
Authors: MARSHALL G. , MITCHELL J. D. , TOBIAS V. , MESSINA I. M.
Published: March 2008

AbstractA case of arrhythmogenic right ventricular dysplasia in a 10 year old girl is described which provides some evidence for an inherited aetiology of this unusual form of heart disease. The parents of this child were first cousins, thus increasing the possibility of inherited disorders in their offspring. She had been known from infancy to have the rare disorder of congenital deficiency of intestinal enteropeptidase, and low serum immmunoglobulins G and A. An untyped adenovirus was grown from a myocardial biopsy taken early in the course of her cardiac disease. However, it is unlikely that this virus was a major factor in the aetiology of her cardiac disease. Both the cardiac and intestinal diseases are now commonly believed to result from hereditary factors, and this report provides further support for this view.
Thirty‐six consecutive under 5 year old domestic swimming pool drownings
Authors: HASSALL I. B.
Published: March 2008

Abstract Data were collected by the local nurse on each of the 36 drownings in domestic swimming pools of under 5 year olds that occurred between 1 September 1982 and 31 December 1986. The likely effect of New Zealand's 1987 Fencing of Swimming Pools Act in preventing these drownings, had it been in effect, is considered. It is concluded that at least 29 (80%) of the 36 drownings would have been prevented. Examination of the circumstances of the drownings leads to the conclusion that certain alternatives to the fencing law that have been proposed, such as teaching water skills to infants, fencing property boundaries, and use of pool covers, are unlikely to have been as effective.
Hyperinsulinism in infancy
Authors: LOW L. C. K. , YU E. C. L. , CHOW O. K. W. , YEUNG C. Y. , YOUNG R. T. T.
Published: March 2008

Abstract Five infants with persistent hypoglycaemia due to hyperinsulinism were reported. Provocative tests for insulin release were unhelpful. Diazoxide was useful in the treatment of three patients but many side‐effects were observed. These included petechial rash, hypertrichosis, acute renal failure, fluid retention and cardiac failure. Two patients underwent spontaneous remission. Three patients had nesidioblastosis, two of whom were subjected to 95% pancreatectomy. Postoperatively, recurrence of hypoglycaemia was due to hyperinsulinism in one patient and to presumed glucagon deficiency in the other. Phenytoin effectively corrected the hypoglycaemia in the patient who had postoperative hyperinsulinism. It is recommended that medical therapy with diazoxide (10–15 mg/kg per day) together with a diuretic be commenced once hyperinsulinism is diagnosed. Subtotal pancreatectomy should be performed early in these patients if hypoglycaemia cannot be controlled with medical therapy or if side‐effects of treatment are documented.
Pneumographic studies: Predictors of future apnoeas but not sudden infant death in asymptomatic infants
Authors: RAHILLY P. M.
Published: March 2008

Abstract Pneumograms were performed on 401 asymptomatic infants: 322 siblings, 15 cousins and 24 twins of sudden infant death syndrome (SIDS) victims; 14 siblings of near‐miss SIDS victims, and 26 infants of anxious parents. The infants of anxious parents had significantly fewer abnormalities than siblings of SIDS victims. In 222 infants subsequently monitored at home, the pneumogram as a predictor of future apnoea had a sensitivity rate of 97.5% and a specificity rate of 72% (P< 0.001). Infants who were to experience future apnoeas had a significantly higher percentage of time in periodic breathing and a higher density of apnoeas in their original pneumograms. However, the abnormal pneumogram did not predict SIDS, because the eight infants who died all had normal pneumograms.
Early identification of cerebral palsy in high risk infants
Authors: BURNS Y. R. , O'CALLAGHAN M. , TUDEHOPE D. I.
Published: March 2008

Abstract This study of high risk infants aimed to identify which signs at the corrected ages of 1, 4 and 8 months were important for distinguishing those infants who later developed hypertonic cerebral palsy (CP). From a total cohort of 450 infants (350 of birthweight < 1500 g and 100 of birthweight > 1500 g), 26 infants were later diagnosed as having CP and formed the study group. A control group of 26 infants from the same initial cohort who did not develop CP was matched to the study group. Both groups were followed for a minimum of 2 years. At each assessment (1, 4, 8, 24 months corrected age), all children were assessed using a standard medical examination and a detailed neurosensorimotor developmental scale that evaluated neurological signs, motor attainments, primitive reflexes and postural reactions. Each test response was graded as normal, suspect or abnormal and the results for the two groups were compared. Assessment at 1 month failed to identify a number of the CP infants whereas at 4 months there was some overidentification. At 8 months, assessment was highly predictive of cerebral palsy. Individual signs of abnormality were found to be of limited value but the presence of three or more abnormal signs at 8 months was highly predictive of CP.
Parents’reports of disability among 13 year olds: Preliminary experiences with WHO'S ICIDH
Authors: LANGLEY J. D.
Published: March 2008

Abstract Disability, as defined by the International Classification of Impairments Disabilities and Handicaps (ICIDH), was studied in a sample of 13 year olds (n= 831) who are involved in a longitudinal study of health, development and behaviour. The disability categories of ICIDH were used to develop a self‐administered questionnaire for completion by parents, and 831 parents completed the questionnaire. The most common reported disabilities were: writing/spelling (26%), coping with dust/pollens or chemicals (15%), and coping with school work (15%). Eighty‐one parents reported that their teenager had some circumstantial dependency; 49 of these mentioned medication that was associated with asthma management. Despite problems in the application of the disability categories of ICIDH, they were considered to provide a useful means by which to study disability systematically among teenagers.
Early childhood development: A comparative study of beliefs held by adolescents, medical students and mothers
Authors: SAWYER M. G. , SARRIS A. , BAGHURST P. A. , WORSLEY A. , KALUCY R. S.
Published: March 2008

Abstract This study examined beliefs about the normal development of preschool children held by adolescents, medical students and mothers. A consistent pattern was identified, with adolescents estimating that young children can do the least, medical students’estimations lying between those of adolescents and mothers, and mothers estimating that the children can do the most. In addition, medical students were found to change their beliefs during the time that they participated in their paediatric teaching programme. It is suggested that paediatricians and other child health professionals take into account the varying beliefs held by different groups in the community when providing advice or teaching about early child development.
Carbohydrate metabolism on high dose growth hormone therapy in children treated for leukaemia
Authors: CRAWFORD B. A. , COWELL C. T. , GREENACRE P. , HOWARD N. J. , STEVENS M. M. , SILINK M.
Published: March 2008

Abstract The effect on carbohydrate metabolism of a high dose growth hormone (GH) regimen (1.2 U/kg per week) was assessed on 24 children who had previously been treated for leukaemia. Sixteen patients received high dose GH and eight patients received a conventional dose of GH (0.6 U/kg per week). Oral glucose tolerance tests (OGTT) were performed at baseline and after 3 months of treatment with GH. For the entire group between 0 and 3 months, there was a significant increase in mean (and standard deviation) fasting plasma glucose (0.3 ± 0.6 mmol/L), fasting insulin level (11 ± 26 mU/L), and 2 h insulin level (20 ± 40 mU/L). One patient, who received a conventional dose of GH, developed substantial carbohydrate intolerance. For the entire group, there was no change in response to a carbohydrate load at 3 months as measured by the area under the plasma glucose or insulin curve. There was no significant difference between conventional and high dose groups at 3 months as assessed by these parameters. This study demonstrates that a higher dose of GH may be used in these children in an attempt to improve their final height, without increased risk of carbohydrate intolerance in the short term.
Nephrotic syndrome in Kawasaki disease
Authors: LEESS B‐W. , YAP H‐K. , YIP W. C. L. , GIAM Y‐C. , TAY J. S. H.
Published: March 2008

Abstract Renal manifestations in Kawasaki disease are rare, and nephrotic syndrome in this disorder has not been described previously. We report a 3 month old infant with Kawasaki disease, presenting with nephrotic syndrome which responded to steroid therapy. The patient, however, developed coronary aneurysms and died of acute myocardial infarction.
Rendu‐Osler‐Weber syndrome in a 9 year old girl presenting with repeated haemoptysis
Authors: ROBINSON P. J. , PHELAN P. D.
Published: March 2008

Abstract A case is reported of Rendu‐Osler‐Weber syndrome presenting in a 9 year old girl as recurrent haemoptysis. Despite a normal chest X‐ray, the patient was found to have multiple areas of angiodysplasia in the major airways of her right lung.
Process evaluation of the bassinet restraint loan scheme in Victoria
Authors: FINOCCHIARO C. , TORPEY S.
Published: March 2008

Abstract The value of the use of safety restraints for all vehicle occupants has been recognized, and corresponding legislation has been implemented in Australia. However, legislation alone has not been sufficient to increase significantly the use of safety restraints for infants. In an attempt to address this issue, a statewide infant safety restraint loan scheme has been in operation in Victoria since May 1985. At the time of this study, 203 of 210 municipalities in Victoria were participating in the scheme.
Deletion analysis for Duchenne (and Becker) muscular dystrophy
Authors: KIMBER R. D. , HYLAND V. J. , HAAN E. A. , MULLEY J. C.
Published: March 2008

Abstract Forty‐three unrelated South Australian boys diagnosed as having either Duchenne or Becker muscular dystrophy were screened for deletions using DNA probes to the dystrophin gene. For the 35 boys with Duchenne muscular dystrophy, the deletion frequency was 43% using a simplified probing strategy based on the probes Cf56a, Cf56b, pERT87‐15 and XJ (XJ1.1 or XJ2.3). The corresponding deletion frequency for the eight boys with Becker muscular dystrophy was 38%. Members of families in which these disorders result from a deletion can now choose to prevent the birth of further affected boys, using an accurate prenatal test for the specific mutation occurring within the family. Deletion analysis also has the potential to clarify the carrier status of women in these families.
The value of C‐reactive protein measurement in the diagnosis of neonatal infection
Authors: SEIBERT K. , YU V. Y. H. , DOERY J. C. G. , EMBURY D.
Published: March 2008

We examined whether serum C‐reactive protein (CRP) measurements used in conjunction with leucocyte counts help in the diagnosis of perinatally acquired and nosocomial infections in very preterm newborn infants. One hundred and twenty‐five infants born at a gestational age between 23 and 31 weeks with respiratory distress were studied at birth. A similar group of 85 infants beyond 3 days of age were also studied on 100 occasions for suspected infection. The diagnosis of proven or probable infection was correlated with abnormal haematology (leucopenia <5000/mm3, leucocytosis >20 000/mm3 or ratio of immature forms to total neutrophils of >0.2) and an elevated CRP (>10 mg/L) singly or in combination. The sensitivity of an elevated CRP was relatively higher than abnormal haematology in both early and late infections and the sensitivity was highest when either test was abnormal. Similarly, the specificity, positive and negative predictive values and efficiency of an elevated CRP was relatively higher than abnormal haematology. The performance of the tests in 45 infants born at 23‐28 weeks gestation was similar to that in 80 infants born at 29‐31 weeks gestation. It was concluded that both CRP and leucocyte counts should be determined as they provide valuable information in the diagnosis of neonatal bacterial infection.
A study of periventricular haemorrhage, post‐haemorrhagic ventricular dilatation and periventricular leucomalacia in Chinese preterm infants
Authors: FOK T‐F. , DAVIES D‐ P. , NG H‐K.
Published: March 2008

Serial cranial ultrasound scans were performed in 178 preterm Chinese infants (gestation <35 weeks, birthweight <2000 g) to study the incidence, age of onset and associating risk factors of periventricular haemorrhage (PVH), and also the occurrence of post‐haemorrhagic ventricular dilatation and periventricular leucomalacia (PVL). Sixty‐four infants developed haemorrhage, giving an incidence of 36%. Among infants of birthweight <1500 and <1000 g the respective incidence was 52 and 69%. Seventy‐two per cent (46 of 64) of haemorrhages were initially detected within the first 3 days of life, but delayed haemorrhage occurring after 1 week of age occurred in nine infants. In eight of these infants PVH had been shortly preceded by a major clinical disaster. Eleven perinatal factors were found to be significantly associated with PVH but only systemic hypotension showed a significant independent association. Post‐haemorrhagic ventricular dilatation developed in 17 (46%) of the 37 infants who survived for more than 1 month after PVH. This was transient in 41%, persistent but stable in 29% and progressive in 29%. PVL was detected in eight infants who survived the initial period following PVH.
Multiple hornet (Vespa orientalis) stings with fatal outcome in a child
Authors: KORMAN S.H. , JABBOUR S. , HARARI M. D.
Published: March 2008

A case of multiple hornet stings is described with a rapidly fatal course due to the combination of massive haemolysis, coagulopathy, rhabdomyolysis, hyperkalaemia, acute renal failure, encephalopathy, hepatotoxicity and hyperglycaemia. These features of systemic envenomation can all be attributed to the toxic properties of Oriental hornet venom described in In vitro and in vivo experimental studies. Greater awareness of these features, aggressive treatment of hyperkalaemia and early institution of treatments such as peritoneal dialysis and plasma exchange may prevent fatalities in such cases.
Five cases demonstrating the distinctive behavioural features of chromosome deletion 17(p 11.2 p 11.2) (Smith‐Magenis syndrome)
Authors: COLLEY A.F. , LEVERSHA M.A. , VOULLAIRE L.E. , ROGERS J.G.
Published: March 2008

Abstract Children with hyperactivity and self‐destructive behaviour present a difficult problem for parents and paediatricians. The syndrome described by Smith and Magenis is due to a deletion on the short arm of chromosome 17: del(17)(p 11.2 p 11.2). Clinical manifestations include brachycephaly and a flat mid‐face; brachydactyly; short, broad hands; mental retardation; and aberrant behaviour, including hyperactivity. We report on five children, and review the literature on a newly recognised syndrome in which the behaviour manifestations may precede and often overshadow the learning disabilities and unusual appearance. In addition, we have found sleep disturbance to be a major feature in our patients.
The weight control practices of 15 year old New Zealanders
Authors: WORSLEY A. , WORSLEY A.J. , McCONNON S. , SILVA P.
Published: March 2008

Abstract More than 800 15 year old members of the Dunedin Multidisciplinary Health and Development study cohort completed a questionnaire designed to provide descriptive data concerning the weight control behaviours of this sample of New Zealand adolescents.

The results showed that approximately 75% of the adolescents were within acceptable body mass index ranges. However 68% of the girls (but only 19% of the boys) wanted to weigh less than their present weight.

Generally, girls were more concerned about their body weight than boys: 26% of girls weighed themselves fortnightly or more often, compared with 12% of boys; 45% of girls reported that they were trying to lose weight at present, compared with 9.5% of boys. The main methods of weight reduction included weight reduction diets (21% of girls, 4% of boys in the previous year); exercise such as jogging, walking, swimming and cycling (60% of girts, 34% of boys); and participation in dieting and fitness clubs (35% of girls, 16% of boys). In addition, 20% of girls reported using techniques such as slimming tablets (3%), cigarette smoking (5%) and self‐induced vomiting (5%) to control weight.

The results show that weight control is a major preoccupation of many girls and some boys. Results are discussed in relation to differential social influences on the sexes, and health consequences.
Headache activity in children and adolescents
Authors: KING N.J. , SHARPLEY C.F.
Published: March 2008

Abstract We examined headache activity in 900 Australian youth aged 10–18, using a self‐report questionnaire. Headache prevalence, duration, severity, symptomatology and precipitants were examined, as well as the self‐statements and coping responses of children. Headaches were experienced by most children, and girls reported more frequent headaches than boys. Common headache symptoms included those traditionally associated with muscle‐contraction headache and migraine. Some children reported that they found headaches to be a terrible experience and ‘wished they would die’ during a headache. Of the various coping responses that were endorsed, the use of medication was the most frequent. Methodological problems include the reliability and validity of self‐report data, and the limitations of cross‐sectional investigations.
Change in Aboriginal childhood morbidity and mortality in Bourke 1971–84
Authors: HARRIS M. F. , KAMIEN M.
Published: March 2008

Abstract In the early 1970s, the Aboriginal community of Bourke attempted to improve its socioeconomic and health status through a number of community development activities. As a result, markers of nutrition in early childhood, housing conditions and access to health care all improved, in spite of a deterioration in employment opportunities and adult health. Coincidentally, most markers of the health of Aboriginal children in Bourke improved over the period 1971–84. In particular, Aboriginal child admissions due to gastroenteritis, eye and ear infections and accidents, and the community prevalence of trachoma, middle ear disease and pneumonia among Aboriginal children, decreased. Skin infections were an exception to this general picture, becoming more prevalent over the period.
Juxta‐epiphyseal pathological fracture of the proximal femur secondary to metaphyseal chondrodysplasia
Authors: MEHLMAN C. T. , MENELAUS M. B.
Published: March 2008

Abstract Metaphyseal chondrodysplasia is a rare disorder of which there are five types: the Jansen type, Schmid type, McKusick type, metaphyseal chondrodysplasia and thymolymphopenia, and metaphyseal chondrodysplasia with malabsorption and neutropenia also known as Shwachman's syndrome. All of the bony changes associated with these disorders are considered to be due to a primary defect in the metaphyseal portion of the growth plate. Accurate diagnosis is of importance as the members of the above‐mentioned pentad have varying genetic implications as well as widely varying prognoses. We report a case of juxta‐epiphyseal pathological fracture of the proximal femur secondary to Shwachman's syndrome. The characteristic radiological appearance and management of this complication have not been described. It is important that appropriate management be instituted in this condition because patients with Shwachman's syndrome carry a good prognosis both for length and quality of life.
Two cases of cri‐du‐chat syndrome with mild phenotypic effect but with different size of 5p deletion
Authors: SMITH A. , FIELD B. , MURRAY R. , NELSON J.
Published: March 2008

Abstract The clinical and cytogenetic findings of two cases of cri‐du‐chat syndrome are described. Both cases were females with only slight growth delay, moderate mental disability and minimal phenotypic effects. The mild phenotype was difficult to correlate with the karyotype, which on GTG and RBG banding showed that each had a regular de novo 5p deletion. The deletion in Case 1 was terminal — 46, XX, del(5) (pter ← p15:2:) and in Case 2 it was interstitial—46, XX, del(5) (pter ← p15.2::p133 ← qter). The deletion in Case 2 was considerably larger than in Case 1.
Endemic methicillin‐resistant Staphylococcus aureus in a special care baby unit: A 2 year review
Authors: WEBSTER J. , FAOAGALI J. L.
Published: March 2008

Abstract During January 1987, methicillin‐resistant Staphylococcus aureus (MRSA) was isolated for the first time from a baby admitted to the special care baby unit of a large metropolitan hospital. Over a 2 year period, of 1574 babies admitted to the unit, at least 573 (36.4%) became colonized with the organism. Only nine (1.6%) developed significant infectious morbidity and one baby died. Minor infections occurred in a further 35 (6.1%). The outbreak remained uncontrolled despite rigid infection control measures. Subsequent emphasis on hand washing, in‐service education and provision of weekly review of the MRSA colonization rates have failed to eliminate the organism from the unit.
Serum digoxin concentration in a neonate with renal and hepatic impairment
Authors: TI T.Y. , LEE H.S. , TAN C. L.
Published: March 2008

Abstract This report demonstrates the questionable usefulness of monitoring digoxin concentrations using the available immunoassays in some clinical situations. The patient reported here showed three characteristics (being a neonate with hepatic and renal impairment) that are associated with the presence of digoxin‐like immunoreactive substances. The patient's serum digoxin concentration continued to rise to a peak of 43.7 nmol/L (34.1 ng/mL), 19 days after administration of the drug was discontinued.
Ethics and the new genetics
Authors: HAAN E. A.
Published: March 2008

Recent developments in recombinant DNA technology have resulted in a rapidly expanding range of new diagnostic and therapeutic opportunities for families with inherited disorders.

They are also beginning to impinge on society as a whole as progressively more is learned about the human genome, as the community becomes more aware of the role of genes in disease, and as we start to consider the implications of being able to define individual susceptibility to both monogenic and multifactorial disorders. As we implement the new technologies, careful consideration must be given to the ethical issues which arise so that maximum benefit can be obtained by individuals and the wider community.
Dexamethasone treatment for bacterial meningitis
Authors: GRIMWOOD K.
Published: March 2008

In the pre‐antibiotic era more than 9096 of children with bacterial meningitis died from their disease. The introduction of antibiotics and intensive care reduced mortality to approximately 5%, but significant morbidity remained. A prospective study of 50 children who recovered from Haemophilus influenzae type b meningitis reported that 28% had significant physical or intellectual disabilities 3 years after their illness.1 The failure of new and more powerful antibiotics to improve the outcome of meningitis meant that other treatment modalities needed to be evaluated.
Do ambient temperature and humidity influence the breast‐milk intake of babies?
Authors: WOODWARD D. R. , CUMMING F. J.
Published: March 2008

Abstract This study explored the possible effect of ambient temperature and humidity on the breast‐milk intakes of Australian infants (n= 35) aged 6–12 weeks. Over a 24 h period, each baby was fed only on milk from the breast; milk intakes, temperature and humidity were monitored. Milk intakes—determined by test‐weighing the baby, with a correction for evaporative losses during feeds—showed a mean of 830 g/24 h, with median 818 and s.d. 152. The mean correction for evaporative losses was 46 g/24 h; omission of this correction would have led to an average underestimate of 5.5% in 24 h intakes. Ambient conditions varied substantially between subjects: 24 h mean temperatures ranged from 14 to 28°C, and humidities from 48 to 97%. Over these ranges, breast‐milk intakes did not appear to be significantly influenced by ambient temperature or ambient humidity; however, the rate of evaporative losses increased by 0.008 g/min for each 1°C rise in ambient temperature.
Infants and atropine: A dangerous mixture
Authors: PICKFORD E. J. , HANSON R. M. , O'HALLORAN M. T. , FENWICK D. , NOBLE P. , McDONALD J. D.
Published: March 2008

Colic in infants is a common but short‐lived problem. Many different theories and treatments for this distressing ailment have been tried over the years, yet the definitive cure remains elusive. Although the risks associated with the use of atropine and its derivatives are well known, they are still prescribed by some in the management of colic. We report a case of serious side effects from the treatment of colic with an atropine containing mixture, in which an error in preparation was identified. In view of the potential for serious toxicity resulting from either inappropriate prescription, preparation or administration, alternative methods of treatment should be employed.
The growing role of fetal echocardiography
Authors: MENAHEM S.
Published: March 2008

The advent of cross‐sectional echocardiography has revolutionized the practice of cardiology. Technical advances have greatly improved resolution, permitting clear definition of anatomical detail and thereby facilitating a segmental approach to congenital heart disease (defining connections) and the visualization of malformations (e.g. aortic valvar stenosis). In addition to being able to assess ventricular function, wall thickness, vessel and chamber size, the advent of Doppler interrogation enables estimation of flow and gradients across valves, vessels, etc. Echocardiography has become increasingly indispensable in clinical practice and its extension to the prenatal area is not surprising, especially as it is regarded as being safe to the growing fetus, thereby permitting repeated examination.1 Winsberg's initial ultrasound recording of a fetal heart,2 has led to great advances in fetal echocardiography permitting anatomical diagnoses, an assessment of cardiac function and also aiding in the treatment of fetal arrhythmias and providing information on fetal well‐being.3 The information so generated has contributed to the formulation of optimal management plans for the pregnancy, delivery and care of the affected neonate.4