bluuebunny/crossref_metadata_2025 huggingface dataset:
Benign transient hyperphosphatasaemia associated with adenovirus infection
Authors: NG PC , CHEUNG CK , TAM JS , LI CK
Published: March 2008

: Benign transient hyperphosphatasaemia in early childhood is a harmless biochemical abnormality which is not commonly known to paediatricians. We describe a typical case in a young child and provide further evidence to support a viral aetiology.
Another vaccine, another treadmill?
Authors: FERSON M. J.
Published: March 2008

Objective: Attention is drawn to possible disadvantages arising from the introduction of universal varicella vaccination in infancy.

Methodology: Comparisons are made between universal infant varicella vaccination and the current measles immunization programme, and a review of current literature on age‐specific complications of varicella and cost‐benefit analyses of varicella vaccination.

Results: Universal infant vaccination will cause a greater proportion of varicella cases to occur in adults, including pregnant women, who are at greater risk of serious complications compared to children. Although economic costs resulting from lost time from work will fall dramatically, health costs may rise.

Conclusions: Universal infant vaccination should only be considered if measles is first controlled, and then only if more information on duration of protection becomes available and combined measles‐mumps‐rubella‐varicella vaccines are approved.
Role of routine lumbar puncture in neonatal sepsis
Authors: KUMAR P. , SARKAR S. , NARANG A.
Published: March 2008

Objective: To evaluate the utility of lumbar puncture done routinely as part of complete workup in neonatal sepsis.

Methodology: Two hundred and nine consecutive lumbar punctures performed in 169 neonates were prospectively evaluated for the diagnosis of meningitis over a 6 month period in a tertiary care referral neonatal unit.

Results: Among babies with ‘suspected clinical sepsis’, five (3.3%) were diagnosed to have meningitis. None of the clinically normal babies with high risk obstetric factors alone had meningitis. The lumbar puncture was traumatic in 22.9%, and in 26.3% the fluid obtained was inadequate for complete analysis. The results were inconclusive in 37% of the cases.

Conclusion: Based on this study, routine lumbar puncture may not be required in clinically normal newborns with adverse obstetric factors. In babies with clinical sepsis, though the yield is not very high; there are no reliable clinical or laboratory markers to predict which babies will have meningitis and hence these babies would warrant a lumbar puncture.
Incidence and outcome of diabetic cerebral oedema in childhood: Are there predictors?
Authors: MEL J. M. , WERTHER G. A.
Published: March 2008

Objective: Information regarding cerebral oedema in diabetic children with ketoacidosis does not point to any causal factor or any predictor of outcome. Cases of diabetic ketoacidosis resulting in cerebral oedema at Royal Children's Hospital, Melbourne, over the last 20 years were reviewed.

Methodology: The study was divided into two 10‐year periods during which different fluid protocols were used. During the earlier period dehydration was corrected rapidly (over six h) with a fluid isotonic for sodium. During the latter period rehydration was over 24 h using half‐normal saline.

Results: A similar number of patients developed cerebral oedema in the two periods (six of 3134 vs six of 3373). Only half of the patients (six) developed cerebral oedema during their initial presentation of diabetes mellitus. The age range was similar (1 to 15 years) with eight males and four females. Survival from cerebral oedema (four of 12) was not predicted by demographic or biochemical findings, including initial biochemistry, age, duration of ketoacidosis and the management protocols.

Conclusions: This study suggests that the rate of salt and water replacement in diabetic ketoacidosis are not key determinants of the appearance of cerebral oedema. No factors predictive of survival from cerebral oedema have been identified, though this is a rare entity and case numbers were small. Nevertheless, current protocols at Royal Children's Hospital and most other centres utilize slow rates of rehydration with isotonic saline fluids. Further review in 5–10 years may determine whether this protocol is effective in reducing rates of cerebral oedema complicating diabetic ketoacidosis.
Growth hormone therapy for 3 years: The OZGROW experience
Authors: COWELL CT , DIETSCH S , GREENACRE P
Published: March 2008

Objective: To examine the growth response over 3 years of growth hormone deficient (GHD) and non‐GHD children who have received growth hormone (GH) in Australia.

Methodology: A retrospective study of a group of patients (1362 children) who commenced GH prior to 1 September 1990. Data were collected at 12 growth centres located in major cities throughout Australia. The data were transferred after informed consent to the national OZGROW database located at the Royal Alexandra Hospital for Children, Sydney, NSW. Of the 1362 children, 898 had received 3 years or more GH therapy and were eligible for this analysis. This cohort was then categorized by diagnosis. Growth response was assessed using height standard deviation score, estimated mature height, growth velocity (GV), GH dose and bone age (years).

Results: For children who completed 3 years therapy, the baseline characteristics among diagnostic groups were similar with mean height standard deviation score (SDS) less than – 3 SDS (except for the malignancy group) and mean GV ranging from 3.5 to 4.4 cm/year. The GV during the first year improved in all groups (7.7‐9.4 cm/year) followed by an attenuated response during the second and third years of therapy. After 3 years GH therapy the GHD group with peak levels <10 mU/L demonstrated the greatest change in estimated mature height and height SDS. The GHD group with peak levels between £10 but <20 mU/L had a growth response similar to the non‐GHD children for all outcome parameters. Change in bone age ranged from 3.1 to 3.8 years with no differences being noted between the diagnostic groups, nor consistently with pubertal status.

Conclusions: Australian GH guidelines have targeted very short children when compared to other series. This large cohort of non‐GHD children has demonstrated short‐term benefits of GH therapy; however, the long‐term benefit remains unclear until these children reach final adult height.
An Angelman syndrome clinic: Report on 24 patients
Authors: LEITNER RP , SMITH A
Published: March 2008

Objective: Angelman syndrome (AS) is a rare congenital neurodevelopmental disorder with complex genetic aetiology. Diagnosis may be difficult and there is severe life‐long disability. An AS clinic was commenced in Sydney, Australia, in 1993 with the aim of gathering information about the natural history of AS, management issues and parental concerns.

Methodology: Patients were referred from metropolitan Sydney, rural New South Wales and interstate. A questionnaire, history, physical examination and diagnostic tests were undertaken.

Results: In the first year, 24 patients with AS were assessed. There were 11 males and 13 females, whose ages ranged from 3 to 30 years. The mean age of diagnosis was 12.8 years. The diagnosis was made by neurologists in four cases, by clinical geneticists in three cases, by paediatricians in two cases and 15 cases were diagnosed at the AS clinic. A clear history of epilepsy was obtained in 19 (79%) and in 15 of these patients the age of onset was during the first 4 years of life. An EEG had been performed in 21 patients, and in two the EEG was reported as normal. Fifteen of the patients (62.5%) could walk independently and in this cohort there was a significant sex difference in walking: 10/11 males compared to 5/13 females (P >0.01). Five patients (21%) were in full‐time permanent care. Genetic testing with appropriate DNA probes from chromosome 15(q11‐13), complete in 20 families, showed deletion in 12 patients (60%), uniparental disomy in 1 (5%) and no detectable abnormality in 7 (35%).

Conclusions: The diagnosis of AS should be considered in any patient with severe developmental disability particularly if there is a movement disorder and lack of speech. The control of epilepsy is a major management problem. Further research is needed to establish the frequency and type of seizures, the reponse to anticonvulsants and to determine if improvement can be expected with age. The mobility of patients should be assessed regularly, to determine the most appropriate options for intervention.
Weight‐for‐age and weight‐for‐height references for Hong Kong children from birth to 18 years
Authors: LEUNG SSF , LAU JTF , TSE LY , OPPENHEIMER SJ
Published: March 2008

Objective: Childhood obesity is an emerging problem in Asia. Sequential monitoring of the growth of an individual can detect a change in body fatness, provided there are ethnically appropriate growth references.

Methodology: A territory wide cross‐sectional growth survey of Hong Kong on 24 709 individuals from the age of newborn to 18 years was performed in 1993. Weight‐for‐age and weight‐for‐height percentile charts were prepared separately for boys and girls.

Results: There was an average increase of 8.5 kg and 5.1 kg in the 18 year old boys and girls, respectively, compared to those surveyed 30 years ago. The percentile curves between 6 and 18 years were similar to those of Singapore. Weight‐for‐height percentile curves were close to those of America in the prepubertal years.

Conclusions: These Hong Kong growth standards for weight‐for‐age and weight‐for‐height are important tools for the assessment of nutritional status of an individual and for monitoring changes in nutritional status of the population.
An evaluation of 1994 school entry immunization certificates on the Central Coast of New South Wales
Authors: WATT PD
Published: March 2008

Objective: To evaluate school entry immunization certificates and document the immunization status of children enrolled during 1994 in kindergartens on the NSW Central Coast.

Methodology: Immunization certificates and non‐statutory documentation of immunization for school entry presented by parents were evaluated during visits to 68 NSW Central Coast schools in May and June 1994.

Results: Immunization information for 3741 kindergarten enrolments was reviewed. Of these enrolments, 79% presented immunization certificates of which 10% were incomplete, 14% presented non‐statutory documentation and 7% had no certificate or non‐statutory documentation. It was considered that 19% of children were incompletely immunized; 8% of certificates presented were incorrectly completed.

Conclusions: The study found that about 80% of Central Coast school entrants were fully immunized. Reliance on immunization certificates as evidence of immunization may overestimate vaccination completion rates, as some certificates may be incorrectly completed. Education of parents, school staff and certificate providers should help to improve both immunization completion and documentation.
Assisted ventilation and survival of extremely low birthweight infants
Authors: DOYLE LW , DAVIS P , DHARMALINGAM A , BOWMAN E
Published: March 2008

Objective: To determine the incremental consumption of ventilator resources associated with the improving survival rate of extremely low birthweight (ELBW, birthweight 500–999 g) infants, from the time assisted ventilation was introduced.

Methodology: Cohort study of ELBW infants born in one tertiary perinatal centre (The Royal Women's Hospital, Melbourne). All ELBW infants born from 1971 to 1993 were included in the study. Inhospital survival rates and patient‐days of assisted ventilation were the main outcome measures. Discrete eras of relatively stable survival rate and consumption of ventilator resources were identified. These comprised the years 1971–74, 1977–83, 1985–90, and 1992–93. Cost‐effectiveness ratios (the incremental consumption of ventilator resources per additional survivor) were calculated between adjacent eras by dividing the increment in the consumption of ventilator resources by the increment in the survival rate.

Results: The survival rates rose progressively between eras (6.2, 33.9, 49.1, 68.8%, respectively, as did the consumption of ventilator resources (0.1, 6.6, 16.2, 24.7 patient‐days of assisted ventilation per livebirth, respectively). The cost‐effectiveness ratio deteriorated initially, increasing from 23.2 to 63.5 additional patient‐days of assisted ventilation per additional survivor, but then improved, falling to 43.1 additional patient‐days of assisted ventilation per additional survivor in the last era. These changes were even more marked for those of birthweight 750‐999 g (20.0, 63.2 to 35.9 additional patient‐days of assisted ventilation per additional survivor, respectively). In contrast, the cost‐effectiveness ratio was initially worse for those of birthweight 500‐749 g, being three‐fold higher than for the larger infants, and only improved substantially in the last era (59.8, 58.3 to 44.1 additional patient‐days of assisted ventilation per additional survivor, respectively).

Conclusions: The initial deterioration in cost‐effectiveness ratios between successive eras probably reflected the increased availability of resources for assisted ventilation, without any other major advances in perinatal care. The improvement in cost‐effectiveness in the last era reflected, in part, the increased use of antenatal steroid therapy and the introduction of exogenous surfactant to neonatal intensive care.
Early post‐traumatic seizures in children: Clinical and radiological aspects of injury
Authors: ONG LC , DHILLON MK , SELLADURAI BM , MAIMUNAH A , LYE MS
Published: March 2008

Objective: To determine the type and outcome of early post‐traumatic seizures in children and the factors associated with it.

Methodology: A prospective observational study on all consecutive children with head injuries at the General Hospital Kuala Lumpur between November 1993 and December 1994. The onset, type and frequency of seizures occurring within the first week of injury were documented. Using inpatients as a cohort, logistic regression analysis was used to determine clinical and radiological variables significantly associated with seizures. The outcome 6 months post‐injury was assessed using the Glasgow Outcome Scale.

Results: Fifty‐three of 966 children (5.5%) developed seizures within the first week of trauma. Seven (13.2%) occurred within 1 h of injury, 30 (56.6%) between 1 and 24 h and 16 (30.2%) after 24 h. Factors significantly associated with early post‐traumatic seizures were female sex, age less than 2 years, loss of consciousness for more than 24 h and acute subdural haematoma (P <0.01). Children with seizures had a poorer outcome (death or severe disability) man inpatients without seizures (21/53 vs 19/182, P <0.001). The outcome was worst in children with recurrent partial seizures, who had a longer injury‐seizure interval and were more likely to have focal neurologic deficits compared to those with sporadic or generalized seizures.

Conclusions: Anticonvulsant prophylaxis to minimize the adverse effects of early seizures in head injury should be considered for young children (less than 2 years old) with subdural haematoma and a prolonged duration of coma. Prompt and effective control of recurrent seizures is recommended.
Neonatology in the ‘Pearl of the East’
Authors: NG PC , FOK TF , NELSON EAS
Published: March 2008

ABSTRACT Clinicians practising in different regions of the world are often impressed at marked differences in disease patterns witnessed. The bases of most obvious differences are usually socio‐economic and genetic, but culture and environment can be equally important. Documenting and assessing such differences is more than just a passing interest. Globalization has resulted in significant movement of people from one area to another. During the past decade, many young Chinese families have emmigratad to Australia, Europe and North America for social and political reasons. Clinicians in these regions will need to be aware of the ‘Chinese disease patterns’. The overview highlights some of the more striking differences seen in neonatal medicine between the East (Hong Kong) and the West (Australia/Europe/North America). In addition to the immediate clinical relevance, it is hoped that this review can provide a background from which fruitful research ideas may emerge and to stimulate interest for trainee neonatologists who wish to seek sabbatical experience in Hong Kong.
Child Behaviour Checklist classification of behaviour disorder
Authors: NOLAN TM , BOND L , ADLER R , LITTLEFIELD L , BIRLESON P , MARRIAGE K , MAWDSLEY A , SALO R , TONGE BJ
Published: March 2008

Objective: The aim of this study was to determine the applicability of the published clinical cut‐off scores of the Child Behaviour Checklist (CBCL) for the classification of behaviour disorders.

Methodology: Child Behaviour Checklists were obtained for 1342 subjects newly referred to the six major mental health centres in Melbourne. The normative community sample of 1002 7‐, 12‐ and 15‐year‐olds was drawn from a school‐based asthma prevalence study.

Results: The mean total problem T‐score for the children referred to mental health centres was 67 and was above the clinical range for all age groups. Using referral to psychiatric services as the gold standard, the sensitivity and specificity of the CBCL using a cut‐off of ≥ 60, was 77.4 and 83.2%, respectively. This compares favourably with the sensitivity of 68% and specificity of 82% for the American sample. Using a cut‐off score of ≥ 63, the sensitivity was 70.5% and the specificity was 88.6%. The referred and community samples differed with respect to socio‐economic status, family structure and mothers' level of education. Fifty‐two per cent of the clinically referred children lived with both parents, compared with 89% of the community sample.

Conclusions: While there are some limitations to this study in terms of both the clinic and community sample, support is provided for the usefulness and applicability of the recommended CBCL cut‐off scores in an Australian population.
CYP11β1 (11‐beta‐hydroxylase) deficiency in congenital adrenal hyperplasia
Authors: BURREN CP , MONTALTO J , YONG ABW , BATCH JA
Published: March 2008

Objective: To review experience of CYP11β1 deficiency (previously known as 11β‐hydroxylase) at the Royal Children's Hospital, Melbourne, Victoria.

Methodology: A retrospective case review was conducted from 1974 to 1995 with five cases identified.

Results: Age of presentation ranged from 1 day to 7 years. Presentation was with ambiguous genitatia at birth (two females), simple virilization (two males) and suspected early puberty in mid childhood (one female). Associated clinical features were hypertension (three cases) and tall stature with markedly advanced bone age (four cases). Biochemical abnormalities consistent with CYP11β1‐deficiency were elevated urinary tetrahydro‐11‐deoxycortisol (n= 5) and elevated serum 11‐deoxycortisol (n= 3). Additional abnormalities were elevated 17‐hydroxyprogesterone (n= 3), elevated androstenedione (n= 4) and elevated dehydroepiandrosterone sulphate (n= 4). The clinical features and investigations suggested CYP11β1‐classical deficiency in four patients and CYP11β1‐non‐classical deficiency in one patient.

Conclusions: The five cases of CYP11β1‐deficiency demonstrate a spectrum of clinical abnormalities, with diagnostic difficulties in two cases and delayed presentation in three cases. Prompt diagnosis of CYP11β1‐deficiency is facilitated greatly by the availability of a gas chromatography‐mass spectrometry instrument and is essential to avoid the long‐term effects of hypertension and hyperandrogenism.
Comparison of morbidities in very low birthweight and normal birthweight infants during the first year of life in a developing country
Authors: BOO NY , ONG LC , LYE MS , CHANDRAN V , TEOH SL , ZAMRATOL S , NYEIN MK , ALLISON L
Published: March 2008

Objective: To compare the morbidities in the very low birthweight (VLBW; < 1500 g) and normal birthweight (NBW; ± 2500 g) Malaysian infants during the first year of life.

Methodology: Prospective observational cohort study of consecutive surviving VLBW infants and randomly sampled NBW infants born in the Kuala Lumpur Maternity Hospital between 1 December 1989 and 31 December 1992. Infants were followed up regularly during the first year of life, after correction for prematurity.

Results: Compared with NBW infants (n= 106), VLBW infants (n= 127) had significantly higher risk of failure to thrive (odds ratio [OR] = 8.0, 95% confidence intervals [Cl]: 1.1 to 354.3), wheezing (OR = 3.7, 95% Cl: 1.6 to 9.3), rehospitalization (OR = 2.3, 95% Cl: 1.1 to 5.0), cerebral palsy (OR = 8.6, 95% Cl: 2.0 to 77.6), neurosensory hearing loss (OR = 12.0, 95% Cl: 1.7 to 513.6) and visual loss (7.9 vs 0%, P= 0.002). The mean mental developmental index (MDI) and mean psychomotor developmental index (PDI) at 1 year of age were significantly lower among VLBW infants (MDI 99 [SD = 28], PDI89 [SD = 25]) than NBW infants (MDI 106 [SD = 18], PDI 101 [SD = 18]) (95% Cl for difference between means being MDI: ‐14.1 to ‐1.7; and PDI: ‐17.6 to ‐6.0). Logistic regression analysis showed that among VLBW infants: (i) male sex, Malay ethnicity and bronchopulmonary dysplasia were significant risk factors associated with wheezing; (ii) longer duration of oxygen therapy during the neonatal period, seizures after the post‐neonatal period and wheezing were significant risk factors associated with rehospitalization; and (iii) longer duration of oxygen therapy during the neonatal period was a significant risk factor associated with adverse neurodevelopmental outcome during the first year of life.

Conclusions: Compared with NBW infants, VLBW Malaysian infants had significantly higher risks of physical and neurodevelopmental morbidities.
Neurological outcome of severe cystic periventricular leukomalacia
Authors: WILKINSON I , BEAR J , SMITH J , GILL A , CHALLINOR C , JONES W , SHAHIDULLAH M , WOODERSON S
Published: March 2008

Objective: To determine the neurological outcome of a cohort of premature babies having ultrasound diagnoses of severe cystic periventricular leukomalacia.

Methodology: All neonatal intensive care unit admissions born at less than 35 weeks gestation or weighing less than 1500 g underwent serial cranial ultrasounds. Those developing severe bilateral cystic periventricular leukomalacia (12 patients) were then followed clinically to a mean age of 27.3 months.

Results: Ten of the 12 patients fulfilling strict ultrasound criteria survived. All had a major neurological handicap, all having spastic quadriparesis and visual impairments, with most suffering global developmental delay and epilepsy.

Conclusions: Severe bilateral cystic periventricular leukomalacia results in major permanent handicap. It is currently impossible to identify most patients with this condition while they are being ventilated. Non‐ultrasound techniques are needed to diagnose the condition earlier, and to give guidance to management.
Risk factors for adverse outcomes of bacterial meningitis
Authors: GRIMWOOD K , NOLAN TM , BOND L , ANDERSON VA , CATROPPA C , KEIR EH
Published: March 2008

Objective: To identify risk factors for adverse outcomes from bacterial meningitis.

Methodology: From a cohort of 166 children with bacterial meningitis who were studied prospectively, 130/158 (82%) survivors underwent neurological, neuropsychological, audiological and behaviour assessments 5–9 years following their illness.

Results: Major adverse outcomes included 8/166 (4.8%) deaths and severe neurological, intellectual or audiological sequelae in 11/130 (8.5%) children followed. Another 24 (18.5%) had cognitive, auditory or behaviour disorders. Bivariate analysis found age ≤12 months, tertiary referral, symptoms >24 h before diagnosis, seizures, focal neurological signs, deteriorating conscious state in hospital, Streptococcus pneumoniae infection and serum sodium concentration < 130 mmol/L were associated with adverse outcomes. Multivariate analysis showed age ≤12 months, symptoms >24 h, seizures after 72 h in hospital and focal neurological signs as independent risk factors. These were present in 18/19 (95%) children with major sequelae, but absent in 9/24 (37.5%) children with minor disabilities.

Conclusions: As minor disabilities following meningitis cannot be predicted, all survivors require assessment during their early school years.
Bilateral chronic conjunctivitis and corneal scarring in a boy with X‐linked hypogammaglobulinaemia
Authors: al GHONAIUM A , ZIEGLER JB , TRIDGELL D
Published: March 2008

ABSTRACT We report an unusual case of bilateral chronic conjunctivitis and corneal scarring in a boy with X‐linked hypogammaglobulinaemia (XLH) who did not respond to the usual antibacterial and antiviral therapy. An immunofluorescence test for Chlamydia trachomatis from an eye swab was strongly positive. Within days of commencement of local and systemic tetracycline therapy, he showed marked improvement. Since conjunctival follicle formation, which depends on the presence of a B‐cell population, may not occur in XLH, clinical examination in chlamydia conjunctivitis may be misleading and lead to a delay in diagnosis and treatment with resulting corneal complications, unless laboratory evidence of chlamydia infection is specifically sought.
Childhood acute lymphoblastic leukaemia presenting as jaundice
Authors: ALVARO F , JAIN M , MORRIS LL , RICE MS
Published: March 2008

ABSTRACT An unusual presentation of acute lymphoblastic leukaemia (ALL) in a 6‐year‐old girl is reported. She presented with unilateral cervical lymphadenopathy, a mixed obstructive/cholestatic jaundice and a progressive pancytopenia. Ultrasound examination revealed an obstructed common bile duct with gross thickening of the wall of the duct and intrahepatic bile duct dilatation. The jaundice resolved with high dose intravenous (i.v.) methylprednisolone. It is postulated that this was due to infiltration of the common bile duct, given the failure to demonstrate any other cause for the bile duct pathology.
Hypokalaemia following nebulized salbutamol in children with acute attack of bronchial asthma
Authors: SINGHI SC , JAYASHREE K , SARKAR B
Published: March 2008

Objective: To determine whether use of nebulized salbutamol therapy for treatment of an acute attack of asthma in children is associated with hypokalaemia and if so what is its frequency, severity and effect on recovery.

Methodology: Forty‐six children, aged 10 months to 12 years (mean 7.9±1.5 years) with acute attack of bronchial asthma, treated initially with three doses of nebulized salbutamol 0.15‐0.3mg/kg, every 30 min participated in the study. Blood for serum potassium was obtained at the beginning and after three doses of nebulized salbutamol therapy, before administering other drugs.

Results: The mean±SD serum potassium level decreased marginally from 3.9±0.5mEq/L to 3.7±0.5mEq/L (P <0.05). A decrease in serum potassium concentration was noted in 26 (56.5%) and hypokalaemia (serum potassium <3.5 mg/L) in 17 (39%) patients. It was more frequent in patients who had received oral salbutamol for the preceding 7 days. The average time taken for recovery was longer in patients who had hypokalaemia than those who had normal serum potassium concentration (8.6±2.7 h vs 6.5±2.7 h; P <0.005).

Conclusions: Hypokalaemia may occur in about one‐third of patients treated with three doses of nebulized salbutamol therapy, especially those on prior oral salbutamol therapy. The monitoring of serum potassium concentration may be warranted in such patients.
Why do Aboriginal newborns weigh less? Determinants of birthweight for gestation
Authors: BLAIR E
Published: March 2008

Objective: To compare birthweight for gestational age of Aboriginal with Caucasian infants and investigate the origins of their differences.

Methodology: Data pertaining to birthweight, gestational age at delivery and pathological factors were abstracted from birth records of 1301 Western Australian singleton Aboriginal pregnancies dated before 24 weeks by ultrasound fetometry and compared with routinely collected data pertaining to Caucasian births of the same period.

Results: Median birthweight for gestation was lower in Aboriginal than in Caucasian infants for deliveries after 35 weeks of gestation, and that of pure‐descent lower than that of mixed‐descent Aboriginal infants at all gestations. Pathological factors (e.g. diabetes, urogenital infections, alcoholism and leprosy) occurring more commonly in Aboriginal than in Caucasian pregnancies accounted for most of the differences in birthweight for gestation between mixed‐descent Aboriginal and Caucasian infants but a discrepancy of almost 180 g remained between pure‐descent Aboriginal and Caucasian infants.

Conclusions: Identified pathological factors contribute but do not entirely explain the lower birthweights for gestation observed in Aboriginal infants.
Bowel habits of healthy Australian children aged 0‐2 years
Authors: THAM EBA , NATHAN R , DAVIDSON GP , MOORE DJ
Published: March 2008

Objective: To define the bowel habits of healthy Australian children aged up to 2 years.

Methodology: One hundred and forty children were recruited in six age categories with a minimum of 20 children per category. Data on bowel habit was recorded by parents daily for 1 week.

Results: Stool frequency decreased with age. Ninety‐five percent of infants 0‐14 days passed more than two stools per day compared with 21% at age 13‐24 months. Breastfed infants passed more frequent and looser stools than children fed infant formula and solids and also showed a wider variation in frequency.

Conclusions: Mean stool frequency decreased with age as did the variation. This is a combined effect of age and feed type. These data can be used as a guide to the bowel habit of healthy Australian children.
Annotation Microvascular complications of insulin‐dependent diabetes: Risk factors, screening and intervention
Authors: COUPER J
Published: March 2008

The ability to detect subclinical signs of the microvascular complications of diabetes during adolescence and our increased understanding of risk factors for their development provide an opportunity to prevent irreversible organ damage. Glycaemic control makes a major contribution to the risk and progression of microvascular complications. However, the unique psychological and physiological changes of childhood and adolescence present a considerable challenge for those attempting to reduce the burden of adult microvascular disease.
Primary omental torsion in children
Authors: KIMBER CP , WESTMORE P , HUTSON JM , KELLY JH
Published: March 2008

Objective: A retrospective review was conducted to establish the prevalence and clinical features of omental torsion or infarction as a cause of acute abdominal pain in childhood.

Methodology: The case records were analysed for all patients admitted with primary omental pathology to the Department of General Surgery, Royal Children's Hospital, Melbourne, between January 1975 and July 1994.

Results: From 1975 to 1994 (20 years) 13 children were admitted to our General Surgical Department with primary omental disease. There were nine males and four females under 16 years of age. The presenting complaint was abdominal pain with vomiting or diarrhoea. Four children had major medical conditions. Pre‐operative diagnosis in all cases was acute appendicitis. Appendicectomy and omentectomy were performed without complication in all cases. Histology of the omentum demonstrated torsion, infarction or haemorrhage.

Conclusions: All children presented with features of acute appendicitis, a majority were male, and two out of the 13 patients were obese. The absence of any children under 4 years was consistent with the relative paucity of omental fat in younger children. We found no clear mechanism for primary omental torsion, although rotation around the right epiploic artery was observed.
Neonatal neutropenia and thrombocytopenia following maternal hypertension
Authors: FRASER SH , TUDEHOPE DI
Published: March 2008

Objective: To assess the relationship between the subtypes of hypertension in pregnancy and subsequent neonatal haematology.

Methodology: Retrospective review of the haematology of newborns of hypertensive mothers at a tertiary neonatal unit

Results: Over a 2 year period. 249 infants had full blood examinations. Nineteen (7.6%) were neutropenic and 35 (14.1%) thrombocytopenic, including 11 (4.4%) who were both neutropenic and thrombocytopenic. Neutropenia occurred only in infants whose mothers had severe pre‐eclampsia and eclampsia or pre‐eclampsia with pre‐existing hypertension, whereas thrombocytopenia complicated all maternal hypertension subtypes. Two (10%) of the neutropenic infants developed nosocomial infection while seven (20%) of the thrombocytopenic infants bled. Thirteen (68%) of the neutropenic infants compared with 15 (43%) of the thrombocytopenic infants developed their haematological abnormality within 24 h of birth. All but two infants developed the haematological abnormality by the 5th day of life.

Conclusions: Although haematological abnormalities in infants born to hypertensive mothers are uncommon, serious neonatal complications can occur and therefore early haematological screening of these infants is recommended.
Reducing the anxiety of children undergoing surgery: Parental presence during anaesthetic induction
Authors: CAMERON JA , BOND MJ , POINTER SC
Published: March 2008

Objective: The primary aim was to determine whether child anxiety could be reduced by the presence of a parent during anaesthetic induction. Secondary aims involved clarification of the effect of the timing of parental separation, the use of premedication, the seriousness of the surgical procedure, and the flow‐on effect of parental anxiety on the level of child anxiety.

Methodology: Subjects were obtained by approaching all parents of children aged from 1 to 8 years admitted for day surgery to a private hospital in Adelaide, South Australia during a 3 month period. Data pertaining to 74 children, representing a response rate of 80.4%, were obtained. Parents were instructed to rate the anxiety of their child for the period immediately prior to separation, and to then rate their own anxiety for the same period of time.

Results: Children accompanied during induction were less anxious than those who were not accompanied. Contrary to the belief that child anxiety might be reduced by allowing separation in the theatre holding bay area, it was demonstrated that child anxiety was higher in this group than when separation occurred in the ward. No relationship between premedication or operation severity and either child or parental anxiety was observed. However, parental anxiety was noted to be a significant predictor of child anxiety. Suggestions for a more detailed examination of the relationship between child and parental anxiety in future research were outlined.

Conclusions: It was concluded that there are benefits in allowing parents to be present during anaesthetic induction. However, the potential negative effect of parental anxiety must be acknowledged before parents are allowed to accompany their child as a matter of course.
Some reasons for concern about attention deficit hyperactivity disorder
Authors: JUREIDINI J
Published: March 2008

Abstract: Attention deficit hyperactivity disorder (ADHD) is not a disease. The symptoms of its three dimensions (activity, attention and impulsivity) are normally distributed in the population, with an arbitrary level of symptoms being designated pathological. The presence of the ADHD cluster is never grounds for any positive diagnosis; it is an indication for further assessment. Positive response to stimulants is not specific to the ADHD population, and is in no way diagnostic.
Birth by vacuum extraction: Neonatal outcome
Authors: VACCAO A
Published: March 2008

Abstract: Subgaleal (subaponeurotic) haemorrhage (SGH) is a serious and sometimes life‐threatening condition associated with vacuum extraction. With increasing use of the vacuum extractor as the preferred instrument for assisted vaginal delivery, neonatal paediatricians should be prepared to encounter a greater number of infants with SGH and other effects associated with vacuum extraction. In order to reduce morbidity and to prevent mortality in infants with SGH, neonatal caregivers should be able to recognize the occurrence of this type of bleeding and to institute appropriate forms of management. This annotation describes the effects of vacuum extraction on the newborn infant and suggests some measures for the management of these conditions.
Early intervention: Professional views and referral practices of Australian paediatricians
Authors: REDDIHOUGH DS , TINWORTH S , MOORE TG , IHSEN E
Published: March 2008

Objective: To gather information from paediatricians concerning their attitudes to early intervention services for young children with developmental disabilities and to study their referral practices.

Methodology: Two hundred and ninety‐five Australian paediatricians completed a postal questionnaire.

Results: Paediatricians presented a positive view of early intervention, particularly for its beneficial impact on families, and perceived the quality of services to be comprehensive or adequate. There were few differences between States, or between country or metropolitan areas. Most paediatricians make prompt referrals to early intervention services when a child has an established disability. Referral is much less likely with suspected delay.

Conclusions: Paediatricians are aware of the benefits of early intervention but additional information concerning the role of these services and their significant impact on families and children should be provided.
A comparison of endoscopic and capsule small intestinal biopsy techniques in children with upper gastrointestinal disorders
Authors: ELTUMI MA , ONG PS , FRANCIS ND , BRUETON MJ
Published: March 2008

Objective: To compare the adequacy for histological diagnosis and morphometric analysis of small intestinal biopsies obtained by either endoscopic forceps or a capsule technique.

Methodology: Small intestinal biopsies from 176 children were reviewed, 92 obtained by endoscopy and 84 by capsule.

Results: The adequacy for making a histological diagnosis was 96 and 81% for endoscopic and capsule biopsies, respectively, and for morphometric analysis it was 86 and 71%. There were more tissue specimens from children who had endoscopic compared with capsule biopsies (2.3 vs 1.8 specimens per patient).

Conclusions: Endoscopic biopsies provide better specimens for histological diagnosis and endoscopy has the advantage of allowing macroscopic assessment of the upper gastrointestinal tract which can be of value in recognizing unexpected pathology and in identifying patchy mucosal changes.
Evaluation of an asthma severity score
Authors: YUNG M , SOUTH M , BYRT T
Published: March 2008

Objective: To evaluate inter‐observer agreement and validity of an asthma severity score derived from wheeze, heart rate and accessory muscle use components.

Methodology: Children with acute asthma were examined independently and simultaneously by two observers, followed by pulse oximetry and spirometry in those over 5 years with repeatable measurements.

Results: Inter‐observer agreement was very good (weighted kappa 0.82, 95% confidence interval 0.63 to 1.00). the component with the best agreement being the accessory muscle score (0.76, 0.57 to 0.95).

The score correlated significantly with oxygen saturation, heart rate, and forced expiratory volume in 1 s (FEV1). In a multivariate model, FEV1 was best related to accessory muscle use.

Conclusions: The asthma severity score has very good inter‐observer agreement with a moderate relationship to oxygenation and FEV1.
Self‐induced overdose of ADHD medication
Authors: PEARSON CC
Published: March 2008

Abstract: Attention deficit hyperactivity disorder is a diagnosis made with increasing frequency and problems related to its drug management are also beginning to appear with increasing frequency.
Potential adverse endocrine effects of inhaled corticosteroids
Authors: BATCH JA
Published: March 2008

Abstract: Evidence exists for a potential role for inhaled corticosteroids, particularly when used in high dose to cause growth impairment, delayed maturation and adrenal suppression in children and adolescents with asthma. The functional significance of biochemical adrenal suppression remains uncertain. Similarly, there is as yet insufficient evidence to determine whether inhaled corticosteroids may adversely affect bone mineral density in children and adolescents with asthma.
Breast‐feeding in neonatal intensive care
Authors: YIP E. , LEE J. , SHEEHY Y.
Published: March 2008

Objective: To determine the incidence of breast‐feeding in very preterm babies while in neonatal intensive care.

Methodology: A retrospective records analysis of all 151 babies with gestational age less than 35 weeks admitted to the neonatal intensive care unit (NICU) of a major teaching hospital in 1993.

Results: On discharge 64% of babies were having some breast milk (45% having breast milk alone, 19% both breast milk and formula), and 38% some breast‐feeding (17% being solely breast‐fed, the other 21% combining breast‐feeding with either bottle‐feeding or an intragastric tube [IGT]). Breast milk was the first milk for 41% of babies, with 83% having breast milk at some stage.

Increasing gestational age was associated with a decreased likelihood of first milk being breast milk (73% of those less than 29 weeks compared to 21% of those aged 33–34 weeks, P<0.001), but with increased rates of breast‐feeding (23 compared to 59%, P= 0.01) and breast milk consumption (42 compared to 73%, P= 0.04).

Conclusions: Breast‐feeding rates in NICU are well below those found on discharge for full term babies. Both maternal and staff‐related factors contribute to this. More and better education of mothers, doctors and nurses as well as changes to some unit practices could increase these rates.
Survey of the definition and screening of neonatal hypoglycaemia in Australia
Authors: BONACRUZ GL , ARNOLD JD , LESLIE GI , WYNDHAM L. , KOUMANTAKIS G.
Published: March 2008

Objective: To determine the approach to identifying neonatal hypoglycaemia and the definition of neonatal hypoglycaemia used by neonatal paediatricians in Australian Level 3 neonatal intensive care units (NICU).

Methodology: A questionnaire was sent to the 101 neonatal paediatricians in the 22 Level 3 NICU in Australia asking their method of screening for, and definition of, neonatal hypoglycaemia.

Results: Responses were received from 70 neonatal paediatricians, including all 22 directors. A bedside glucose meter is used in 19 of 22 NICU to screen for hypoglycaemia, whilst one NICU uses a glucose analyzer and another NICU uses a visual colour comparison method. One NICU does not screen, but has blood glucose measured in a satellite laboratory. If the screening method suggests hypoglycaemia, 62 of 63 neonatal paediatricians proceed to blood glucose determination in a laboratory, mostly using plasma samples. Based on the laboratory measurement, the definition of neonatal hypoglycaemia ranged from <1.1 to 3.0 mmol/L.

Conclusions: The majority of neonatal paediatricians in Australian NICU screen for neonatal hypoglycaemia using a bedside glucose meter. There is a wide range in the definition of neonatal hypoglycaemia from <1.1 to 3.0mmol/L.
Mothers' knowledge of the risk factors and anxiety about SIDS
Authors: COOPER RM , LUMLEY J.
Published: March 2008

Objective: To assess the impact on mothers' knowledge and anxiety of the 1991‐92 health promotion campaign on Sudden Infant Death Syndrome (SIDS) risk factors.

Methodology: A telephone survey of a population based sample of 339 mothers in Victoria, Australia, conducted 1992‐94.

Results: Recall by mothers of the risk factors for SIDS was as follows: not breast‐feeding. 15%; smoking, 46%; overheating, 48%; and prone sleeping, 84%. Recall rate increased as the campaign progressed. Receiving the campaign pamphlet was associated with an increased recall of all risk factors. Discussion of the pamphlet with a health professional was rare (9%). One‐third of all mothers reported being very worried about cot death when caring for their babies. Self‐reported worry was significantly more common among mothers whose babies were born at the time of the campaign introduction.

Conclusions: The campaign pamphlets were effective in increasing knowledge of the risk factors. The limited discussion with health professionals suggests that future campaigns need increased professional involvement to address problems, including anxiety among new mothers.
Prednisolone and cellulose phosphate treatment in idiopathic infantile hypercalcaemia with nephrocalcinosis
Authors: MIZUSAWA Y. , BURKE JR
Published: March 2008

Abstract: A girl presented at the age of 8 months with idiopathic infantile hypercalcaemia complicated by hypercalciuria, nephrocalcinosis and failure to thrive. Her hypercalcaemia was partially corrected by prednisolone, but resolved with the addition of cellulose phosphate. Her height and weight showed significant improvement during the treatment period. Cellulose phosphate should be considered in the management of children with idiopathic infantile hypercalcaemia and nephrocalcinosis.
A national study of risk factors associated with mortality in very low birthweight infants in the Malaysian neonatal intensive care units
Authors:   MALAYSIAN VERY LOW BIRTH WEIGHT STUDY GROUP
Published: March 2008

Objective:

To determine the risk factors associated with mortality in very low birthweight (VLBW) infants admitted to the neonatal intensive care units (NIUC) in Malaysia.

Method:

A prospective observational study of outcome of all VLBW infants born between 1 January 1993 and 30 June 1993 and admitted to the NICU.

Results:

Data of 868 VLBW neonates from 18 centres in Malaysia were collected. Their mean birthweight was 1223 g (95% confidence intervals: 1208–1238 g). Thirty‐seven point four per cent (325/868) of these infants died before discharge. After exclusion of all infants with congenital anomalies (n=66, and nine of them also had incomplete records) and incomplete records (n=82), stepwise logistic regression analysis of the remaining 720 infants showed that the risk factors that were significantly associated with increased mortality before discharge were: delivery in district hospitals, Chinese race, lower birthweight, lower gestation age, persistent pulmonary hypertension of the newborn, pulmonary airleak, necrotizing enterocolitis of stage 2 or 3, confirmed sepsis, hypotension, hypothermia, acute renal failure, intermittent positive pressure ventilation, and umbilical arterial catheterization. Factors that were significantly associated with lower risk of mortality were: use of antenatal steroid, oxygen therapy, surfactant therapy and blood transfusion.

Conclusion:

The mortality of VLBW infants admitted to the Malaysian NICU was high and was also associated with a number of preventable risk factors.